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National Cholesterol Education Program risk assessment and potential for risk misclassification
Stephen D Persell1, Donald M Lloyd-Jones, David W Baker
1Division of General Internal Medicine, Northwestern University, 676 N. St. Clair Street, Suite 200, Chicago, IL 60611-2927, USA. spersell@mnff.org
Preventive Medicine
|August 16, 2006
Summary
The National Cholesterol Education Program Adult Treatment Panel (ATP III) guidelines may misclassify over 5 million adults as low risk for coronary heart disease. This occurs when using risk factor counts instead of multivariable methods, particularly affecting middle-aged and older men.
Area of Science:
- Cardiology
- Preventive Medicine
- Public Health
Background:
- The National Cholesterol Education Program Adult Treatment Panel (ATP III) guidelines recommend risk assessment for coronary heart disease (CHD) using multivariable methods only for adults with two or more risk factors.
- This approach may lead to misclassification of individuals with fewer than two risk factors but a nonetheless elevated 10-year CHD risk.
Purpose of the Study:
- To determine the proportion of adults with fewer than two risk factors who are falsely classified as low risk for CHD.
- To identify characteristics of individuals misclassified by the ATP III risk factor counting method.
Main Methods:
- Analysis of 4097 adults aged 20-79 without diagnosed cardiovascular disease or diabetes from the 1999-2002 National Health and Nutrition Examination Survey.
- Calculation of 10-year risk of cardiac death or myocardial infarction using multivariable methods (Framingham Risk Score).
- Comparison of risk classification using the risk factor counting method versus multivariable methods.
Main Results:
- Among individuals with fewer than two risk factors, 5.3% (approx. 5.64 million US adults) had a 10-year CHD risk of 10% or greater and were misclassified as low risk.
- Misclassified individuals were significantly older and more likely to be male compared to those correctly classified.
- Specifically, 85.5% of misclassified individuals were male, versus 41.2% of those correctly classified.
Conclusions:
- Relying solely on the ATP III risk factor counting method leads to the underestimation of CHD risk in a substantial number of adults.
- Over 5 million adults, predominantly middle-aged and older men, may be misclassified as low risk, missing opportunities for preventive interventions.
- Multivariable risk assessment should be considered for all adults, irrespective of the number of traditional risk factors, to ensure accurate CHD risk stratification.
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