Risk score overestimation: the impact of individual cardiovascular risk factors and preventive therapies on the performance of the American Heart Association-American College of Cardiology-Atherosclerotic Cardiovascular Disease risk score in a modern multi-ethnic cohort

• Published in: European heart journal Vol. 38; no. 8; pp. ehw301 - 608
• Main Authors: DeFilippis, Andrew Paul, Young, Rebekah, McEvoy, John W., Michos, Erin D., Sandfort, Veit, Kronmal, Richard A., McClelland, Robyn L., Blaha, Michael J.
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 21.02.2017
• Subjects: Adult; Aged; American Heart Association; Asian - statistics & numerical data; Black or African American - statistics & numerical data; Cardiology; Clinical Research; Coronary Artery Disease - epidemiology; Coronary Artery Disease - ethnology; Coronary Artery Disease - prevention & control; Female; Hispanic or Latino - statistics & numerical data; Humans; Male; Middle Aged; Prospective Studies; Risk Assessment; Sex Distribution; United States - epidemiology; White People - ethnology; United States; Prevention; Cardiovascular risk prediction; Risk factors
• ISSN: 0195-668X; 1522-9645; 1522-9645
• DOI: 10.1093/eurheartj/ehw301

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. 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). 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.