Application of a Lifestyle-Based Score to Predict Cardiovascular Risk in African Americans: The Jackson Heart Study

Area of Science:

• Cardiology
• Epidemiology
• Public Health

Background:

• Cardiovascular disease (CVD) prevention requires accessible risk assessment tools for diverse populations.
• Existing CVD risk prediction models may not perform optimally across different ethnic groups.
• The Jackson Heart Study provides a valuable cohort for evaluating risk models in African Americans.

Purpose of the Study:

• To evaluate the performance of the Healthy Heart Score, a lifestyle-based tool, for estimating CVD risk in an African American population.
• To determine if the Healthy Heart Score improves CVD risk prediction beyond age alone in this demographic.
• To assess the discriminative and calibration performance of the tool.

Main Methods:

• Prospective cohort study of 5306 African American participants from the Jackson Heart Study (2000-2004).
• Utilized the Healthy Heart Score, a model incorporating BMI, physical activity, smoking, and diet.
• Assessed model discrimination with Harrell's C-Index and time-dependent AUC; evaluated calibration using plots.

Main Results:

• The Healthy Heart Score demonstrated high-moderate discrimination for CVD events (C-statistic 0.75).
• Performance improvement over an age-only model was minimal.
• Both models showed better performance and good calibration in participants without diabetes at baseline.

Conclusions:

• The Healthy Heart Score does not significantly enhance CVD event prediction in African Americans beyond using age alone.
• Lifestyle-based risk prediction tools require further validation and refinement for specific populations.
• Age remains a critical factor in CVD risk assessment for African Americans.