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The new pooled cohort equations risk calculator

David Preiss1, Søren L Kristensen2

  • 1BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom.

The Canadian Journal of Cardiology
|April 7, 2015
PubMed

Insights

The new ACC/AHA Pooled Cohort Equations calculator predicts atherosclerotic cardiovascular disease (ASCVD) risk, including stroke and race for better accuracy. However, potential overestimation may lead to unnecessary statin prescriptions.

Area of Science:

  • Cardiology
  • Preventive Medicine
  • Health Risk Assessment

Background:

  • Traditional cardiovascular risk assessment relied on Framingham scores.
  • The 2013 American College of Cardiology (ACC) and American Heart Association (AHA) guidelines necessitated a new risk prediction tool.
  • The ACC/AHA Pooled Cohort Equations Risk Calculator was developed to address these needs.

Purpose of the Study:

  • To review the development of the ACC/AHA Pooled Cohort Equations Risk Calculator.
  • To discuss the strengths and weaknesses of this new cardiovascular risk assessment tool.
  • To explore the implications of its routine use in clinical practice.

Main Methods:

  • The review analyzes the foundation of the ACC/AHA Pooled Cohort Equations, based on major National Heart, Lung, and Blood Institute cohort studies.
  • It examines the inclusion of specific endpoints like stroke and demographic factors such as race.
  • The methodology also considers criticisms regarding potential risk overestimation.

Main Results:

  • The calculator predicts 10-year risk of hard atherosclerotic cardiovascular disease (ASCVD) events, including nonfatal myocardial infarction, fatal coronary heart disease, and stroke.
  • Strengths include the incorporation of stroke as an endpoint and race as a characteristic, improving prediction for African-American individuals.
  • It also provides lifetime ASCVD risk estimates for adults aged 20-59.

Conclusions:

  • The ACC/AHA Pooled Cohort Equations offer advancements in cardiovascular risk prediction by including stroke and race.
  • Omissions such as chronic kidney disease and social deprivation are notable weaknesses.
  • Potential overestimation of ASCVD risk requires further validation to prevent overtreatment with statins.

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