Andrew Paul DeFilippis1,2,3, Rebekah Young4, John W McEvoy2, Erin D Michos2, Veit Sandfort5, Richard A Kronmal4, Robyn L McClelland4, Michael J Blaha2. 1. Jewish Hospital, Louisville, KY, USA. 2. Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA. 3. Division of Cardiovascular Medicine, University of Louisville, 550 South Jackson Street, Louisville, KY 40202, USA. 4. University of Washington, Seattle, WA, USA. 5. National Institutes of Health, Bethesda, MD, USA.
Abstract
AIMS: To evaluate the 2013 American Heart Association (AHA)-American College of Cardiology (ACC)-Atherosclerotic Cardiovascular Disease (ASCVD) risk score among four different race/ethnic groups and to ascertain which factors are most associated with risk overestimation by the AHA-ACC-ASCVD score. METHODS AND RESULTS: The Multi-Ethnic Study of Atherosclerosis (MESA), a prospective community-based cohort, was used to examine calibration and discrimination of the AHA-ACC-ASCVD risk score in 6441 White, Black, Chinese, and Hispanic Americans (aged 45-79 years and free of known ASCVD at baseline). Using univariable and multivariable absolute risk regression, we modelled the impact of individual risk factors on the discordance between observed and predicted 10-year ASCVD risk. Overestimation was observed in all race/ethnic groups in MESA and was highest among Chinese (252% for women and 314% for men) and lowest in White women (72%) and Hispanic men (67%). Higher age, Chinese race/ethnicity (when compared with White), systolic blood pressure (treated and untreated), diabetes, alcohol use, exercise, lipid-lowering medication, and aspirin use were all associated with more risk overestimation, whereas family history was associated with less risk overestimation in a multivariable model (all P < 0.05). CONCLUSION: The AHA-ACC-ASCVD risk score overestimates ASCVD risk among men, women, and all four race/ethnic groups evaluated in a modern American primary prevention cohort. Clinicians treating patients similar to those in MESA, particularly older individuals and those with factors associated with more risk overestimation, may consider interpreting absolute ASCVD risk estimates with caution. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: To evaluate the 2013 American Heart Association (AHA)-American College of Cardiology (ACC)-Atherosclerotic Cardiovascular Disease (ASCVD) risk score among four different race/ethnic groups and to ascertain which factors are most associated with risk overestimation by the AHA-ACC-ASCVD score. METHODS AND RESULTS: The Multi-Ethnic Study of Atherosclerosis (MESA), a prospective community-based cohort, was used to examine calibration and discrimination of the AHA-ACC-ASCVD risk score in 6441 White, Black, Chinese, and Hispanic Americans (aged 45-79 years and free of known ASCVD at baseline). Using univariable and multivariable absolute risk regression, we modelled the impact of individual risk factors on the discordance between observed and predicted 10-year ASCVD risk. Overestimation was observed in all race/ethnic groups in MESA and was highest among Chinese (252% for women and 314% for men) and lowest in White women (72%) and Hispanic men (67%). Higher age, Chinese race/ethnicity (when compared with White), systolic blood pressure (treated and untreated), diabetes, alcohol use, exercise, lipid-lowering medication, and aspirin use were all associated with more risk overestimation, whereas family history was associated with less risk overestimation in a multivariable model (all P < 0.05). CONCLUSION: The AHA-ACC-ASCVD risk score overestimates ASCVD risk among men, women, and all four race/ethnic groups evaluated in a modern American primary prevention cohort. Clinicians treating patients similar to those in MESA, particularly older individuals and those with factors associated with more risk overestimation, may consider interpreting absolute ASCVD risk estimates with caution. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Maryam Kavousi; Maarten J G Leening; David Nanchen; Philip Greenland; Ian M Graham; Ewout W Steyerberg; M Arfan Ikram; Bruno H Stricker; Albert Hofman; Oscar H Franco Journal: JAMA Date: 2014-04-09 Impact factor: 56.272
Authors: Paul Muntner; Lisandro D Colantonio; Mary Cushman; David C Goff; George Howard; Virginia J Howard; Brett Kissela; Emily B Levitan; Donald M Lloyd-Jones; Monika M Safford Journal: JAMA Date: 2014-04-09 Impact factor: 56.272
Authors: David C Goff; Donald M Lloyd-Jones; Glen Bennett; Sean Coady; Ralph B D'Agostino; Raymond Gibbons; Philip Greenland; Daniel T Lackland; Daniel Levy; Christopher J O'Donnell; Jennifer G Robinson; J Sanford Schwartz; Susan T Shero; Sidney C Smith; Paul Sorlie; Neil J Stone; Peter W F Wilson; Harmon S Jordan; Lev Nevo; Janusz Wnek; Jeffrey L Anderson; Jonathan L Halperin; Nancy M Albert; Biykem Bozkurt; Ralph G Brindis; Lesley H Curtis; David DeMets; Judith S Hochman; Richard J Kovacs; E Magnus Ohman; Susan J Pressler; Frank W Sellke; Win-Kuang Shen; Sidney C Smith; Gordon F Tomaselli Journal: Circulation Date: 2013-11-12 Impact factor: 29.690
Authors: Andrew P DeFilippis; Rebekah Young; Christopher J Carrubba; John W McEvoy; Matthew J Budoff; Roger S Blumenthal; Richard A Kronmal; Robyn L McClelland; Khurram Nasir; Michael J Blaha Journal: Ann Intern Med Date: 2015-02-17 Impact factor: 25.391
Authors: Ralph B D'Agostino; Ramachandran S Vasan; Michael J Pencina; Philip A Wolf; Mark Cobain; Joseph M Massaro; William B Kannel Journal: Circulation Date: 2008-01-22 Impact factor: 29.690
Authors: Diane E Bild; David A Bluemke; Gregory L Burke; Robert Detrano; Ana V Diez Roux; Aaron R Folsom; Philip Greenland; David R Jacob; Richard Kronmal; Kiang Liu; Jennifer Clark Nelson; Daniel O'Leary; Mohammed F Saad; Steven Shea; Moyses Szklo; Russell P Tracy Journal: Am J Epidemiol Date: 2002-11-01 Impact factor: 4.897
Authors: Avinainder Singh; Bradley L Collins; Ankur Gupta; Amber Fatima; Arman Qamar; David Biery; Julio Baez; Mary Cawley; Josh Klein; Jon Hainer; Jorge Plutzky; Christopher P Cannon; Khurram Nasir; Marcelo F Di Carli; Deepak L Bhatt; Ron Blankstein Journal: J Am Coll Cardiol Date: 2017-11-12 Impact factor: 24.094
Authors: Dennis T Ko; Atul Sivaswamy; Maneesh Sud; Gynter Kotrri; Paymon Azizi; Maria Koh; Peter C Austin; Douglas S Lee; Idan Roifman; George Thanassoulis; Karen Tu; Jacob A Udell; Harindra C Wijeysundera; Todd J Anderson Journal: CMAJ Date: 2020-04-27 Impact factor: 8.262
Authors: Donald M Lloyd-Jones; Mark D Huffman; Kunal N Karmali; Darshak M Sanghavi; Janet S Wright; Colleen Pelser; Martha Gulati; Frederick A Masoudi; David C Goff Journal: Circulation Date: 2016-11-04 Impact factor: 29.690
Authors: Donald M Lloyd-Jones; Mark D Huffman; Kunal N Karmali; Darshak M Sanghavi; Janet S Wright; Colleen Pelser; Martha Gulati; Frederick A Masoudi; David C Goff Journal: J Am Coll Cardiol Date: 2016-11-04 Impact factor: 24.094
Authors: Adam Leigh; John W McEvoy; Parveen Garg; J Jeffrey Carr; Veit Sandfort; Elizabeth C Oelsner; Matthew Budoff; David Herrington; Joseph Yeboah Journal: JACC Cardiovasc Imaging Date: 2018-02-14