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

Autor:	Beaudoin JR; Department of Family and Community Medicine, University of California, Davis, California., Curran J; Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland., Alexander GC; Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.; Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, Maryland.
Jazyk:	angličtina
Zdroj:	AJPM focus [AJPM Focus] 2024 Feb 02; Vol. 3 (2), pp. 100200. Date of Electronic Publication: 2024 Feb 02 (Print Publication: 2024).
DOI:	10.1016/j.focus.2024.100200
Abstrakt:	Introduction: The use of race in clinical risk prediction tools may exacerbate racial disparities in healthcare access and outcomes. This study quantified the number of individuals reclassified for primary prevention of cardiovascular disease owing to a change in their race alone on the basis of a commonly used risk prediction tool. Methods: This is a cross-sectional analysis of individuals aged 40-75 years without a history of cardiovascular events, diabetes, or other high-risk features using the 2005-2018 National Health and Nutritional Examination Survey. Authors compared atherosclerotic cardiovascular disease risk scores using the American Heart Association/American College of Cardiology equation recommended for White individuals or individuals of other races with that recommended for Black individuals. Results: A total of 2,946 White individuals; 1,361 Black individuals; and 2,495 individuals of other races were included in the analysis. Using the American Heart Association/American College of Cardiology equation, the mean 10-year atherosclerotic cardiovascular disease risk was 5.80% (95% CI=5.54, 6.06) for White individuals, 7.04% (956% CI=6.69, 7.39) for Black individuals, and 4.93% (95% CI=4.61, 5.24) for individuals of other races. When using the American Heart Association/American College of Cardiology equation designated for the opposite race (White/other race versus Black), the mean atherosclerotic cardiovascular disease risk score increased by 1.02% (95% CI=0.90, 1.13) for White individuals, decreased by 1.82% (95% CI= -1.67, -1.96) for Black individuals, and increased by 0.98% (95% CI=0.85, 1.10) for individuals of other races. When using clinical atherosclerotic cardiovascular disease categories of <7.5%, 7.5%-10%, and >10%, 16.93% of all individuals were reclassified when using the American Heart Association/American College of Cardiology's equation designated for the opposite race. Conclusions: Changing race within a commonly used cardiovascular risk prediction tool results in significant changes in risk classification among eligible White and Black individuals in the U.S. Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: G. Caleb Alexander reports a relationship with FDA's Peripheral and Central Nervous System Advisory Committee that includes: consulting or advisory. G. Caleb Alexander reports a relationship with Monument Analytics that includes: equity or stocks. Dr. Alexander is past Chair and a current member of FDA's Peripheral and Central Nervous System Advisory Committee; is a co-founding Principal and equity holder in Monument Analytics, a health care consultancy whose clients include the life sciences industry as well as plaintiffs in opioid litigation, for whom he has served as a paid expert witness; and is a past member of OptumRx's National P&T Committee. These arrangements have been reviewed and approved by Johns Hopkins University in accordance with its conflict of interest policies. (© 2024 Published by Elsevier Inc. on behalf of The American Journal of Preventive Medicine Board of Governors.)
Databáze:	MEDLINE
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