An analysis of calibration and discrimination among multiple cardiovascular risk scores in a modern multiethnic cohort

Accurate risk assessment of atherosclerotic cardiovascular disease (ASCVD) is essential to effectively balance the risks and benefits of therapy for primary prevention. To compare the calibration and discrimination of the new American Heart Association (AHA) and American College of Cardiology (ACC)...

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Bibliographic Details
Published in:Annals of internal medicine Vol. 162; no. 4; p. 266
Main Authors: DeFilippis, Andrew P, Young, Rebekah, Carrubba, Christopher J, McEvoy, John W, Budoff, Matthew J, Blumenthal, Roger S, Kronmal, Richard A, McClelland, Robyn L, Nasir, Khurram, Blaha, Michael J
Format: Journal Article
Language:English
Published: United States 17.02.2015
Subjects:
Aged
Aged, 80 and over
American Heart Association
Antihypertensive Agents - therapeutic use
Aspirin - therapeutic use
Calibration
Coronary Artery Disease - epidemiology
Coronary Artery Disease - ethnology
Coronary Artery Disease - prevention & control
Diabetes Complications
Female
Follow-Up Studies
Humans
Hypolipidemic Agents - therapeutic use
Male
Middle Aged
Myocardial Revascularization
Platelet Aggregation Inhibitors - therapeutic use
Practice Guidelines as Topic
Primary Prevention
Prospective Studies
Risk Assessment - methods
Risk Assessment - standards
United States - epidemiology
Voluntary Health Agencies
United States
ISSN:1539-3704, 1539-3704
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Summary:Accurate risk assessment of atherosclerotic cardiovascular disease (ASCVD) is essential to effectively balance the risks and benefits of therapy for primary prevention. To compare the calibration and discrimination of the new American Heart Association (AHA) and American College of Cardiology (ACC) ASCVD risk score with alternative risk scores and to explore preventive therapy as a cause of the reported risk overestimation using the AHA-ACC-ASCVD score. Prospective epidemiologic study of ASCVD. MESA (Multi-Ethnic Study of Atherosclerosis), a community-based, sex-balanced, multiethnic cohort. 4227 MESA participants aged 50 to 74 years and without diabetes at baseline. Observed and expected events for the AHA-ACC-ASCVD score were compared with 4 commonly used risk scores-and their respective end points-in MESA after a 10.2-year follow-up. The new AHA-ACC-ASCVD and 3 older Framingham-based risk scores overestimated cardiovascular events by 37% to 154% in men and 8% to 67% in women. Overestimation was noted throughout the continuum of risk. In contrast, the Reynolds Risk Score overestimated risk by 9% in men but underestimated risk by 21% in women. Aspirin, lipid-lowering or antihypertensive therapy, and interim revascularization did not explain the overestimation. Comparability of MESA with target populations for primary prevention and possibility of missed events in MESA. Of the 5 risk scores, 4, including the new AHA-ACC-ASCVD score, showed overestimation of risk (25% to 115%) in a modern, multiethnic cohort without baseline clinical ASCVD. If validated, overestimation of ASCVD risk may have substantial implications for individual patients and the health care system. National Heart, Lung, and Blood Institute.
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ISSN:1539-3704
1539-3704
DOI:10.7326/M14-1281