Race as a Component of Cardiovascular Disease Risk Prediction Algorithms

Vasan, Ramachandran S.; Rao, Shreya; Heuvel, Edwin van den

doi:10.1007/s11886-023-01938-y

Cited by 3 publications

(3 citation statements)

References 76 publications

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“…Thus, it is recommended to develop race-free CVD risk prediction algorithms. 46 In individuals without hypertension, the negative association between OBS and 10-years ASCVD risk is more pronounced, indicating that antioxidant-rich diets and healthy lifestyles confer incredible benefits in participants without hypertension. Studies have shown that antioxidant-rich diets, including carotenoids, vitamin E, and magnesium supplements, are negatively associated with hypertension.…”

Section: Discussionmentioning

confidence: 99%

A cross-sectional study exploring the relationship between oxidative balance score and 10-year atherosclerotic cardiovascular disease risk based on the National Health and Nutrition Examination Survey (2011–2020)

Wang,

Gao,

Wang

et al. 2024

Diabetes and Vascular Disease Research

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Background The intricate interaction between oxidative stress and atherosclerotic cardiovascular disease (ASCVD) is an essential area of research because of the potential role of oxidative homeostasis in regulating ASCVD risk. This study aimed to investigate the relationship between the oxidative balance score (OBS) and the 10-years risk of ASCVD to gain insight into how oxidative balance affects cardiovascular health. Methods This cross-sectional study analyzed National Health and Nutrition Examination Survey (NHANES) 2011–2020 data (40–79 age group), exploring OBS’s link to 10-years ASCVD risk. OBS categorized dietary and lifestyle factors. Multivariate logistic regression controlled for age, sex, race, and demographics. A restricted cubic spline examined linear relationships; robustness was ensured through subgroup analyses. Results Analysis of 4955 participants reveals a negative association between OBS and 10-years ASCVD risk. Continuous OBS adjusted OR: 0.97 (95% CI: 0.95∼0.99, p < .001). Quartile analysis shows reduced risk in Q2 0.88 (95% CI: 0.63∼1.22, p = .43), Q3 0.92 (95% CI: 0.66∼1.28, p = .614), and Q4 0.59 (95% CI: 0.42∼0.83, p = .002) compare Q1. Quartile analysis indicated decreasing risk in higher OBS quartiles. Lifestyle OBS and Dietary OBS demonstrated similar trends. Stratified analyses highlight race and hypertension as effect modifiers ( p < .05). Conclusion Our study suggests an association between higher OBS and a reduced 10-years ASCVD risk. However, causation should not be inferred, and in the future, more extensive clinical and fundamental research is required to delve deeper into this association.

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Section: Discussionmentioning

confidence: 99%

A cross-sectional study exploring the relationship between oxidative balance score and 10-year atherosclerotic cardiovascular disease risk based on the National Health and Nutrition Examination Survey (2011–2020)

Wang,

Gao,

Wang

et al. 2024

Diabetes and Vascular Disease Research

View full text Add to dashboard Cite

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“…Therefore, many have advocated for the measurement and inclusion of measures of structural racism or other SDOH (eg, education, income, social deprivation index) that may be able to be intervened on. [149][150][151] For example, QRISK, a UK-based prediction model for CVD, incorporates a postcode-level deprivation index (Townsend deprivation score). 152 Furthermore, the inclusion of race in risk prediction may imply that differences by race are not modifiable and may reify race as a biological construct, which may worsen health disparities.…”

Section: Removal Of Race From Cvd Risk Prediction Equationsmentioning

confidence: 99%

“…Therefore, although the PREVENT equations represent a critical step forward, integration of the social deprivation index is only a first step; the inclusion of relevant measures that represent individual experiences of discrimination, structural and systemic racism, and individual-and place-based SDOH should be a priority in risk prediction moving forward. 150,151,153 As we move forward and strive to transform care delivery to equitably improve CKM health, we must acknowledge the contributions of structural and systemic racism in CVD risk. We should monitor for the potential of unintended consequences that may lead to systematically underestimating risk in disenfranchised groups who may already be less likely to be appropriately prescribed evidence-based medications (eg, statins, novel glucose-lowering drugs) to reduce CVD risk.…”

Section: Removal Of Race From Cvd Risk Prediction Equationsmentioning

confidence: 99%

Novel Prediction Equations for Absolute Risk Assessment of Total Cardiovascular Disease Incorporating Cardiovascular-Kidney-Metabolic Health: A Scientific Statement From the American Heart Association

Khan,

Coresh,

Pencina

et al. 2023

Circulation

109

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Cardiovascular-kidney-metabolic (CKM) syndrome is a novel construct recently defined by the American Heart Association in response to the high prevalence of metabolic and kidney disease. Epidemiological data demonstrate higher absolute risk of both atherosclerotic cardiovascular disease (CVD) and heart failure as an individual progresses from CKM stage 0 to stage 3, but optimal strategies for risk assessment need to be refined. Absolute risk assessment with the goal to match type and intensity of interventions with predicted risk and expected treatment benefit remains the cornerstone of primary prevention. Given the growing number of therapies in our armamentarium that simultaneously address all 3 CKM axes, novel risk prediction equations are needed that incorporate predictors and outcomes relevant to the CKM context. This should also include social determinants of health, which are key upstream drivers of CVD, to more equitably estimate and address risk. This scientific statement summarizes the background, rationale, and clinical implications for the newly developed sex-specific, race-free risk equations: PREVENT (AHA Predicting Risk of CVD Events). The PREVENT equations enable 10- and 30-year risk estimates for total CVD (composite of atherosclerotic CVD and heart failure), include estimated glomerular filtration rate as a predictor, and adjust for competing risk of non-CVD death among adults 30 to 79 years of age. Additional models accommodate enhanced predictive utility with the addition of CKM factors when clinically indicated for measurement (urine albumin-to-creatinine ratio and hemoglobin A1c) or social determinants of health (social deprivation index) when available. Approaches to implement risk-based prevention using PREVENT across various settings are discussed.

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