February Condition Watch: Cardiovascular Health

Recalculating Risk: Using the PREVENT Risk Equations

Cardiovascular risk calculators have been incorporated into treatment considerations, guidelines, and patient education for almost 30 years. The first widely used risk calculator originated with the famous Framingham Heart Study in Framingham, Massachusetts. The Framingham Risk Score calculator was published in 1998 and predicted the 10-year risk estimate of coronary heart disease. It included sex-specific equations based on factors such as age, smoking status, blood pressure, and cholesterol.

To address the shortcomings of the original calculator, in 2013, the American Heart Association (AHA) published the Pooled Cohort Equations (PCEs), which are sex- and race-specific. The PCEs used a large population of approximately 25,000 patients from 5 community cohorts, increasing the racial diversity of the equation population. In addition, the PCEs expanded results for atherosclerotic cardiovascular disease (ASCVD) outcomes, including stroke. The risk estimates were incorporated into many guidelines, such as the 2013, 2018, and 2019 American College of Cardiology (ACC)/AHA guidelines on cardiovascular disease primary prevention and cholesterol management.

In 2023, the AHA published the Predicting Risk of Cardiovascular Disease Events (PREVENT). These updated risk equations were meant to address 3 key areas, which the AHA defined as: “1) The need for risk equations based on contemporary, diverse data sets that include individuals who are representative of the patient population intended for use, 2) incorporation of predictors and outcomes relevant to the growing burden of chronic kidney disease and heart failure, and 3) expansion to include younger adults starting at 30 years of age with a longer time horizon for estimated risk.” To achieve this, the equations were derived from a large data set composed of more than 6.6 million adults from 46 study cohorts and electronic medical record data.

Since its publication in 2023, PREVENT has not been incorporated into any major guidelines until 2025. The 2025 guideline on high blood pressure by ACC/AHA et al incorporated the PREVENT calculator into its decision tree recommendations, replacing the PCEs. In stage I hypertension, patients without CVD or other comorbidities are recommended to initiate antihypertensive treatment if they have a PREVENT composite score of greater than or equal to 7.5%. Additionally, the 2025 American Diabetes Association Standards of Care in Diabetes recommend assessment of ASCVD risk, but removed a specific calculator in this recommendation. With future guideline updates, PREVENT may continue to replace the PCEs as the recommended risk calculation. However, for now, the PREVENT results can better inform discussions with patients about their risk of cardiovascular disease events.

Read the entire article at https://www.pharmacytimes.com/view/recalculating-risk-introducing-the-prevent-risk-equations

Pharmacists at the Center of Heart Failure Care: Navigating HFpEF and Finerenone Use

Heart failure with preserved ejection fraction (HFpEF) is becoming increasingly prevalent and remains one of the most challenging forms of cardiovascular disease to manage. For pharmacists, the complexity of this condition highlights the need for careful navigation of treatment options, including the emerging role of finerenone (Kerendia; Bayer Pharmaceuticals, Inc), a nonsteroidal mineralocorticoid receptor antagonist (MRA) now under study for patients with HFpEF and heart failure with mildly reduced ejection fraction (HFmrEF). During a Pharmacy Times Clinical Forum, a group of pharmacists discussed how they are approaching this evolving treatment landscape and the potential impact of finerenone in practice.

HFpEF accounts for nearly half of all heart failure cases and is closely linked with comorbid conditions such as diabetes and chronic kidney disease (CKD). Despite the high prevalence of HFpEF, therapeutic options have historically been limited compared with those for heart failure with reduced ejection fraction. However, with the arrival of new data on SGLT2 inhibitors and MRAs, opportunities to improve care are expanding. Pharmacists play a pivotal role in identifying patients eligible for these treatments, ensuring therapy initiation, and managing safety and access concerns as these treatments become part of daily practice.

HFpEF is both underdiagnosed and undertreated, in part due to documentation gaps. “Lots of times when I’m looking at these regional patients, they’re not on a cardiology service.… I don’t think it’s on their radar,” Brad Williams, PharmD, BCPS, FHFSA, a clinical pharmacy coordinator for Cleveland Clinic in Ohio, said during the roundtable.

The intricate nature of HFpEF—most times linked to hypertension, atrial fibrillation, obesity, and CKD—makes the management of the condition more complicated. The latest US data estimate that HFpEF accounts for up to 50% of all heart failure cases and is associated with high morbidity and hospitalization rates.

HFpEF and HFmrEF continue to challenge clinicians, but pharmacists are stepping forward as key drivers of improved care. From identifying patients and overcoming cost barriers to managing hyperkalemia and interpreting trial data, pharmacists are critical in translating evolving evidence into practice. As finerenone and other therapies expand the treatment toolbox, pharmacists will remain essential to ensuring patients receive safe, effective, and accessible care, anchoring the multidisciplinary team in a rapidly evolving field.

Read the full article at https://www.pharmacytimes.com/view/pharmacists-at-the-center-of-heart-failure-care-navigating-hfpef-and-finerenone-use

Updated Hypertension Guidelines Are Here

Approximately half of adults in the US have hypertension. Updated hypertension guidelines were published in August 2025 by organizations including the American College of Cardiology and the American Heart Association (AHA), with recommendations on pharmacotherapy and lifestyle. Pharmacists can incorporate the updated hypertension guidelines through their medication therapy management (MTM) practices.

The AHA Predicting Risk of Cardiovascular Disease Events risk calculator was incorporated into the new guidelines to help determine when to start antihypertensive medications. This calculator estimates cardiovascular disease risk in patients and provides updated recommendations.

Managing hypertension during pregnancy is a priority, and the guidelines include new recommendations. Patients with hypertension who are pregnant or planning to become pregnant should be educated about the use of low-dose aspirin to prevent preeclampsia.

The first-line medications during pregnancy are labetalol and extended-release nifedipine. The typical starting dose of labetalol is 100 to 200 mg twice daily, and the recommended dosage ranges from 200 to 2400 mg/d in 2 or 3 divided doses. Labetalol should be avoided in patients with certain conditions, such as asthma, bradycardia, heart block, decompensated cardiac function, and preexisting myocardial disease. The nifedipine starting dosage is generally 30 to 60 mg once daily. The daily recommended dosage typically ranges from 30 to 120 mg. Nifedipine immediate release should be reserved for hospitalized patients with severe hypertension, and sublingual nifedipine should be avoided to prevent hypotension and fetal problems.

Pharmacists can play an important role in managing severe hypertension during pregnancy, which is defined as systolic blood pressure of 160 mm Hg or greater, or diastolic blood pressure of 110 mm Hg or greater. Patients experiencing severe hypertension should receive antihypertensive medications within 30 to 60 minutes to prevent serious complications such as preterm birth, perinatal death, and maternal death.

Important lifestyle modifications were added to the new guidelines. Pharmacists can counsel patients about lifestyle changes during MTM consults. Avoiding alcohol or limiting it to 1 or fewer drinks for women and 2 or fewer drinks for men per day is part of the new recommendations, given that alcohol increases systolic blood pressure.

An additional lifestyle change is using potassium-based salt substitutes in adults with or without hypertension. These can prevent or treat elevated blood pressure and hypertension, especially when salt is added during food preparation.

Read the original article at https://www.pharmacytimes.com/view/updated-hypertension-guidelines-are-here