Risk score overestimation: the impact of individual cardiovascular risk factors and preventive therapies on the...

Area of Science:

• Cardiology
• Public Health
• Epidemiology

Background:

• The 2013 AHA-ACC-ASCVD risk score is widely used for primary prevention of atherosclerotic cardiovascular disease.
• Accurate risk assessment is crucial for guiding therapeutic interventions.
• Previous studies have suggested potential disparities in risk score performance across different populations.

Purpose of the Study:

• To evaluate the performance of the 2013 AHA-ACC-ASCVD risk score across four race/ethnic groups.
• To identify factors associated with the overestimation of ASCVD risk by the AHA-ACC-ASCVD score.

Main Methods:

• Analysis of the Multi-Ethnic Study of Atherosclerosis (MESA) cohort (n=6441).
• Inclusion of White, Black, Chinese, and Hispanic Americans aged 45-79, free of known ASCVD at baseline.
• Application of univariable and multivariable absolute risk regression to model risk factor impact on score discordance.

Main Results:

• The AHA-ACC-ASCVD risk score demonstrated overestimation of 10-year ASCVD risk in all race/ethnic groups studied.
• Risk overestimation was highest among Chinese Americans (252% for women, 314% for men) and lowest in White women (72%) and Hispanic men (67%).
• Factors associated with increased risk overestimation included higher age, Chinese ethnicity, elevated systolic blood pressure, diabetes, alcohol/exercise use, and lipid-lowering/aspirin use; family history was associated with less overestimation.

Conclusions:

• The AHA-ACC-ASCVD risk score overestimates ASCVD risk in men, women, and all four race/ethnic groups within the MESA cohort.
• Clinicians should interpret absolute ASCVD risk estimates with caution, especially for older patients and those with factors linked to greater risk overestimation.
• Further research may be needed to refine risk prediction models for diverse populations.