Changes in risk factor status and risk of future ASCVD events in primary prevention

Primary cardiovascular prevention highlights the management of risk factors through lifestyle changes and therapeutic interventions. While most previous studies focused on the presence of risk factors assessed only at baseline, temporal changes in the risk factor status were not considered. We aimed to evaluate the prognostic impact of temporal changes in risk factor status in primary prevention settings. A population-based cohort of 211,077 individuals who underwent repetitive 10-year atherosclerotic cardiovascular disease (ASCVD) risk assessments over 4–5 years, was identified from National Health Insurance Services claims data of South Korea. Changes in risk-factor status for blood pressure, glycemic control, cholesterol levels, smoking status, body-mass index, and physical activity were assessed. Hazard ratios (HR) for ASCVD events after follow-up screening were calculated based on increased or decreased risk factors between baseline and follow-up. Regardless of baseline status, increased risk factors correlated with higher future ASCVD risk, while a decrease corresponded to a lower risk. Notably, individuals initially without risk factors but developing three at follow-up faced significantly higher ASCVD risk (adjusted HR 2.74, 95% CI: 1.31– 5.76). Conversely, those decreasing three risk factors from 5 or 6 exhibited almost a 50% reduction in ASCVD risk. These findings show that primary prevention effects can be reflected by changes in risk factor status, underscoring the need to monitor temporal changes in risk factors for effective primary prevention. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement None. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was approved by the institutional review board of Seoul National University Bundang Hospital. The requirement for informed consent was waived by the institutional review board of Seoul National University Bundang Hospital, given that the records and information of study population were anonymized and de-identified from the National Health Insurance Services claims data of South Korea. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Anonymized data are publicly available from the National Health Insurance Sharing Service and can be accessed at .