Performance of the ACC/AHA Pooled Cohort Cardiovascular Risk Equations in Clinical Practice.

Area of Science:

• Cardiology
• Public Health
• Epidemiology

Background:

• The performance of the American College of Cardiology/American Heart Association pooled cohort equation (PCE) for atherosclerotic cardiovascular disease (ASCVD) risk prediction in real-world clinical practice is not extensively evaluated.
• Real-world validation is crucial for understanding the applicability of cardiovascular risk prediction models.

Purpose of the Study:

• To evaluate the predictive performance of the PCE for ASCVD risk in a community-based cohort.
• To determine if including individuals with out-of-range values (age, blood pressure, cholesterol) or statin initiation affects PCE's predictive capabilities.

Main Methods:

• Validation of PCE using a community-based cohort (1997-2016) from Olmsted County, Minnesota.
• Ascertainment of patient information via the Rochester Epidemiology Project record linkage system.
• Duplicate validation of ASCVD events (myocardial infarction, ischemic stroke) and comparison of calculated vs. observed risks and c-statistics.

Main Results:

• The study included 30,042 adults with a median follow-up of 16.5 years (truncated to 10 years).
• The PCE demonstrated good overall performance (c-statistic 0.78), with variations across subgroups.
• Out-of-range values and statin initiation did not significantly impact the model's predictive performance.

Conclusions:

• The PCE performs well in a real-world clinical practice setting.
• Current ASCVD prevention strategies based on PCE are applicable even for patients with values outside the standard range or on statin therapy.
• Findings support the utility of PCE in diverse patient populations for ASCVD risk assessment.