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. 2017 Mar 17;6(3):e005676.
doi: 10.1161/JAHA.117.005676.

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

Lisandro D Colantonio  1 , Joshua S Richman  2 , April P Carson  3 , Donald M Lloyd-Jones  4 , George Howard  5 , Luqin Deng  3 , Virginia J Howard  3 , Monika M Safford  6 , Paul Muntner  3 , David C Goff Jr  7
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Performance of the Atherosclerotic Cardiovascular Disease Pooled Cohort Risk Equations by Social Deprivation Status

Lisandro D Colantonio et al. J Am Heart Assoc. .

Abstract

Background: The atherosclerosis cardiovascular disease (ASCVD) Pooled Cohort risk equations have shown different calibration across US populations with varied levels of social deprivation.

Methods and results: We 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).

Conclusions: The Pooled Cohort risk equations have good calibration among individuals with social deprivation but overestimate ASCVD risk among those with less social deprivation.

Keywords: cardiovascular disease; primary prevention; risk assessment; risk factor; socioeconomic position.

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Figures

Figure 1
Figure 1
Cumulative incidence of atherosclerotic cardiovascular disease by social deprivation status. US$ indicates US dollars.
See this image and copyright information in PMC

References

    1. Goff DC Jr, Lloyd‐Jones DM, Bennett G, Coady S, D'Agostino RB, Gibbons R, Greenland P, Lackland DT, Levy D, O'Donnell CJ, Robinson JG, Schwartz JS, Shero ST, Smith SC Jr, Sorlie P, Stone NJ, Wilson PW, Jordan HS, Nevo L, Wnek J, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH, DeMets D, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, Smith SC Jr, Tomaselli GF; American College of Cardiology/American Heart Association Task Force on Practice G . 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129:S49–S73. - PubMed
    1. Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, Goldberg AC, Gordon D, Levy D, Lloyd‐Jones DM, McBride P, Schwartz JS, Shero ST, Smith SC Jr, Watson K, Wilson PW, Eddleman KM, Jarrett NM, LaBresh K, Nevo L, Wnek J, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH, DeMets D, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, Smith SC Jr, Tomaselli GF. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129:S1–S45. - PubMed
    1. Ridker PM, Cook NR. Statins: new American guidelines for prevention of cardiovascular disease. Lancet. 2013;382:1762–1765. - PubMed
    1. Cook NR, Ridker PM. Further insight into the cardiovascular risk calculator: the roles of statins, revascularizations, and underascertainment in the Women's Health Study. JAMA Intern Med. 2014;174:1964–1971. - PMC - PubMed
    1. Final report on the aspirin component of the ongoing Physicians' Health Study. Steering Committee of the Physicians' Health Study Research Group. N Engl J Med. 1989;321:129–135. - PubMed

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