Performance of the Atherosclerotic Cardiovascular Disease Pooled Cohort Risk Equations by Social Deprivation Status

Abstract

BackgroundThe atherosclerosis cardiovascular disease (ASCVD) Pooled Cohort risk equations have shown different calibration across US populations with varied levels of social deprivation.Methods and ResultsWe analyzed the calibration and discrimination of the Pooled Cohort risk equations by social deprivation status among 9066 REGARDS (REasons for Geographic And Racial Differences in Stroke) study participants not taking statins for whom ASCVD risk may lead to statin initiation. Patients were aged 45 to 79 years, had no ASCVD or diabetes mellitus, and had a low‐density lipoprotein cholesterol level 70 to 189 mg/dL. Social deprivation was defined using 3 indicators: annual household income <$25 000, less than a high school education, and living without a partner. At baseline in 2003–2007, 54.6%, 27.4%, and 18.0% of participants had 0, 1, and 2 or 3 indicators showing deprivation, respectively. From baseline through December 2012, 457 participants developed ASCVD (nonfatal/fatal stroke, myocardial infarction, or coronary heart disease death). Predicted and observed ASCVD incidence per 1000 person‐years were 8.02 and 6.23 (95% CI, 5.31–7.31), respectively, among participants with 0 indicators of deprivation (Hosmer–Lemeshow P=0.01); 8.05 and 6.61 (95% CI, 5.29–8.24), respectively, with 1 indicator (P=0.09); and 9.83 and 11.40 (95% CI, 9.23–14.05), respectively, with 2 or 3 indicators (P=0.12). The C‐index (95% CI) was 0.72 (0.69–0.75), 0.73 (0.69–0.78), and 0.70 (0.65–0.75) among participants with 0, 1, and 2 or 3 indicators of deprivation, respectively. The net reclassification improvement after adding deprivation data to the Pooled Cohort risk equations was modest (0.12; 95% CI, 0.03–0.21).ConclusionsThe Pooled Cohort risk equations have good calibration among individuals with social deprivation but overestimate ASCVD risk among those with less social deprivation.

Evaluation of the Pooled Cohort Risk Equations for Cardiovascular Risk Prediction in a Multiethnic Cohort From the Women’s Health Initiative

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Ischemia and No Obstructive Coronary Artery Disease (INOCA): What Is the Risk?

“…Whether knowledge of the enrolled MESA subjects’ coronary artery calcium score led to activities to reduce risk is not clear 51. The Atherosclerotic Cardiovascular Disease score accurately predicted risk in the Reasons for geographic and racial differences in stroke, a contemporary US dataset that includes representative ethnicity and socioeconomic status 52. A recent study in stable INOCA patients undergoing Coronary Reactivity Testing (CRT) demonstrated that a majority were classified as intermediate risk by FRS, which did not accurately predict MACE, while the addition of coronary macro‐ and microvascular endothelial dysfunction to the FRS correctly reclassified 23%, with a net reclassification index of 0.23 53.…”

Pooled cohort equations heart failure risk score predicts cardiovascular disease and all-cause mortality in a nationally representative sample of US adults

“…We sought to evaluate differences in predicted HF risk across key sociodemographic strata. While both predicted and actual CVD events vary by education and living status, income level, and living environment [26,27], the role of these sociodemographic factors in predicting incident HF remains largely unexplored. Low socioeconomic status, and its correlates, including low educational attainment, are independent risk factors for CVD events, including non-fatal myocardial infarction and sudden cardiac death, in both men and women [28].…”