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Association of Original and Revised Pooled Cohort Equations With Cardiovascular and Cerebrovascular Mortality

Chuanhao Lu1, Min Li2, Deyu Sun3

  • 1Department of Neurosurgery, Xijing Hospital, The Fourth Military Medical University, China.

CNS Neuroscience & Therapeutics
|January 3, 2026
PubMed

Insights

The Revised Pooled Cohort Equations (RPCE) provide better calibration for cardiovascular disease (CVD) and cerebrovascular disease (CeVD) mortality risk prediction than the Pooled Cohort Equations (PCE), especially in diverse populations. RPCE offers more accurate risk estimates, aiding in tailored prevention strategies.

Area of Science:

  • Public Health
  • Epidemiology
  • Cardiovascular Research

Background:

  • Cardiovascular diseases (CVD) and cerebrovascular diseases (CeVD) are leading causes of mortality.
  • The Pooled Cohort Equations (PCE) are widely used for atherosclerotic cardiovascular disease (ASCVD) risk prediction but have calibration concerns, especially in diverse populations.
  • The Revised Pooled Cohort Equations (RPCE) were developed to improve upon PCE, but their performance for CVD and CeVD mortality is less understood.

Purpose of the Study:

  • To comprehensively compare the association of PCE and RPCE with CVD mortality and combined CVD and CeVD mortality.
  • To conduct subgroup analyses by race and gender within a US adult population.
  • To evaluate the calibration and predictive performance of PCE versus RPCE for vascular mortality.

Main Methods:

  • Analysis of 16,584 primary prevention participants (aged 40-79) from the National Health and Nutrition Examination Survey (1999-2018) linked to mortality data.
  • Calculation of 10-year ASCVD risk using both PCE and RPCE, with Bland-Altman plots assessing score agreement.
  • Cox proportional hazards models evaluated associations of standardized scores with CVD and combined CVD/CeVD mortality, with adjustments and stratification by race and gender.

Main Results:

  • Both PCE and RPCE were significantly associated with CVD and combined CVD/CeVD mortality.
  • PCE consistently overestimated risk compared to RPCE, with greater discrepancies at higher risk levels.
  • RPCE demonstrated improved calibration, particularly in racially diverse populations where PCE overestimation was more pronounced.

Conclusions:

  • Both PCE and RPCE are robust prognostic tools for vascular mortality.
  • RPCE offers improved calibration and more conservative, yet comparably predictive, risk estimates, especially in diverse populations.
  • Selecting risk models tailored to specific populations is crucial for optimizing prevention and avoiding overtreatment.
Abstract

Keywords:
cardiovascular mortalitycerebrovascular mortalitypooled cohort equationsvascular risk assessment

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