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Clinical Implications of Revised Pooled Cohort Equations for Estimating Atherosclerotic Cardiovascular Disease Risk.
Pubmed ID: 29868850
Journal: Annals of internal medicine
Publication Date: July 3, 2018
Affiliation: Center for Primary Care and Outcomes Research and Center for Population Health Sciences at Stanford University, Stanford, California, and Center for Primary Care at Harvard Medical School, Boston, Massachusetts (S.B.).
MeSH Terms: Humans, Male, Adult, Female, Aged, Risk Factors, United States, Middle Aged, Risk Assessment, Models, Statistical, Coronary Artery Disease, White People, Black or African American
Grants: N01 HC095159, P30 DK092926, UL1 TR001079, HHSN268201300049C, HHSN268201300048C, HHSN268201300047C, HHSN268201300050C, HHSN268201300046C, N01 HC095167, N01 HC095161, N01 HC095164, N01 HC095166, N01 HC095160, N01 HC095169, N01 HC095165, N01 HC095168, UL1 TR000040, N01 HC095163, N01 HC095162, K08 HL121056, U54 MD010724, DP2 MD010478, UL1 TR001420, I01 HX002014, IK2 HX001368
Authors: Hayward RA, Basu S, Sussman JB, Yadlowsky S, McClelland RL, Min YI
Cite As: Yadlowsky S, Hayward RA, Sussman JB, McClelland RL, Min YI, Basu S. Clinical Implications of Revised Pooled Cohort Equations for Estimating Atherosclerotic Cardiovascular Disease Risk. Ann Intern Med 2018 Jul 3;169(1):20-29. Epub 2018 Jun 5.
Studies:
- Action to Control Cardiovascular Risk in Diabetes (ACCORD)
- Atherosclerosis Risk in Communities Study (ARIC)
- Cardiovascular Health Study (CHS)
- Coronary Artery Risk Development in Young Adults (CARDIA)
- Framingham Heart Study (FHS) Offspring (OS) and OMNI 1 Cohorts
- Multi-Ethnic Study of Atherosclerosis (MESA)
- The Jackson Heart Study (JHS)
Abstract
BACKGROUND: The 2013 pooled cohort equations (PCEs) are central in prevention guidelines for cardiovascular disease (CVD) but can misestimate CVD risk. OBJECTIVE: To improve the clinical accuracy of CVD risk prediction by revising the 2013 PCEs using newer data and statistical methods. DESIGN: Derivation and validation of risk equations. SETTING: Population-based. PARTICIPANTS: 26 689 adults aged 40 to 79 years without prior CVD from 6 U.S. cohorts. MEASUREMENTS: Nonfatal myocardial infarction, death from coronary heart disease, or fatal or nonfatal stroke. RESULTS: The 2013 PCEs overestimated 10-year risk for atherosclerotic CVD by an average of 20% across risk groups. Misestimation of risk was particularly prominent among black adults, of whom 3.9 million (33% of eligible black persons) had extreme risk estimates (<70% or >250% those of white adults with otherwise-identical risk factor values). Updating these equations improved accuracy among all race and sex subgroups. Approximately 11.8 million U.S. adults previously labeled high-risk (10-year risk ≥7.5%) by the 2013 PCEs would be relabeled lower-risk by the updated equations. LIMITATIONS: Updating the 2013 PCEs with data from modern cohorts reduced the number of persons considered to be at high risk. Clinicians and patients should consider the potential benefits and harms of reducing the number of persons recommended aspirin, blood pressure, or statin therapy. Our findings also indicate that risk equations will generally become outdated over time and require routine updating. CONCLUSION: Revised PCEs can improve the accuracy of CVD risk estimates. PRIMARY FUNDING SOURCE: National Institutes of Health.