Impact of Race on Classification of Atherosclerotic Risk Using a National Cardiovascular Risk Prediction Tool

Area of Science:

• Cardiology
• Health Disparities
• Medical Informatics

Background:

• Race is a factor in some clinical risk prediction tools.
• The use of race in these tools may worsen existing healthcare disparities.
• This study investigates the impact of race on cardiovascular disease risk assessment.

Purpose of the Study:

• To quantify how changing race alone affects cardiovascular disease risk scores.
• To analyze reclassification for primary prevention based on race in risk prediction.

Main Methods:

• Cross-sectional analysis of 40-75 year olds from 2005-2018 National Health and Nutritional Examination Survey.
• Compared atherosclerotic cardiovascular disease (ASCVD) risk scores using the AHA/ACC equation for different racial groups.
• Evaluated risk scores when applying equations designated for the 'opposite' race.

Main Results:

• Mean 10-year ASCVD risk differed across White, Black, and other races.
• Applying the 'opposite' race equation altered risk scores: increased for White/other, decreased for Black individuals.
• 16.93% of all individuals were reclassified into different ASCVD risk categories when race was changed.

Conclusions:

• Altering race in a common cardiovascular risk tool significantly changes risk classification.
• This highlights potential inequities in cardiovascular disease primary prevention.
• The findings underscore the need to critically evaluate race's role in risk prediction models.