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. 2018 Apr:198:18-24.
doi: 10.1016/j.ahj.2017.12.005. Epub 2017 Dec 7.

Improving patient risk communication: Translating cardiovascular risk into standardized risk percentiles

Ann Marie Navar  1 , Michael J Pencina  2 , Hillary Mulder  2 , Pierre Elias  2 , Eric D Peterson  2
Affiliations

Improving patient risk communication: Translating cardiovascular risk into standardized risk percentiles

Ann Marie Navar et al. Am Heart J. 2018 Apr.

Abstract

Background: Current cholesterol guidelines recommend using 10-year risk of atherosclerotic cardiovascular disease (ASCVD) to guide informed decisions regarding statin therapy, yet patients may have difficulty conceptualizing absolute risk estimates. Peer comparisons may provide an improved tool for patient risk comprehension.

Methods: Using data from the 2009-2014 National Health and Nutrition Examination Survey (NHANES), we estimated standardized risk percentiles for various age-, sex-, and race-specific subgroups based on their 10-year ASCVD risks using the Pooled Cohort Equations.

Results: We examined 9160 adults in NHANES who were free of cardiovascular disease and had complete clinical data. Among specific age, sex, and race groups, we estimated the distribution of 10-year risk, calculating the 10-year risk corresponding to each percentile in order to generate standardized cardiovascular risk percentiles. Estimated 10-year ASCVD absolute risk varied markedly by age, sex, and race subgroups. A 10-year risk of 7.0% would put a 55 year-old black male in the 20th percentile relative to his peers (ie, at lower risk than 80% of his peers), whereas a 10-year risk of 7.0% would put a 55 year-old white female in the 95th percentile (i.e., only 5% of her peers would have higher risk). Standardized cardiovascular risk percentiles by age, race, and sex are available online at populationrelativerisk.dcri.org.

Conclusion: Cardiovascular risk varies substantially by age, sex, and race. These data allow for 10-year absolute risks of ASCVD to be translated into a standardized cardiovascular risk percentile, providing patients with information that is easy to understanding regarding how their personal risk of cardiovascular disease compares with their age-, sex-, and race-matched peers.

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Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES

AM Navar: Dr. Navar is supported by a research grant from NHLBI (K01HL133416-01), and receives research funding from Amgen Inc., Sanofi Pharmaceuticals, and Regeneron Pharmaceuticals, as well as honoraria for research consulting for Sanofi and Amgen Inc.

MJ Pencina: Dr. Pencina reports research support from Regeneron and Sanofi Pharmaceuticals.

H Mulder: Ms. Mulder has no relevant disclosures to report.

P Elias: Dr. Elias has no relevant disclosures to report.

ED Peterson: Dr. Peterson receives consultant/honoraria from AstraZeneca, Bayer, Janssen, Merck & Co., Sanofi; research grants from AstraZeneca, Bayer, Daiichi Sankyo, Genetech, Janssen, Regeneron, Sanofi, Merck & Co, and Amgen Inc.

Figures

Figure 1
Figure 1. Risk Percentiles of 10-year ASCVD Risk
Cardiovascular disease risk percentiles of 10-year ASCVD risk age 45, 55, 65, and 75 in United States adults free of CVD, grouped by: a) non-black males; b) black males; c) non-black females; and d) black females. ASCVD indicates atherosclerotic cardiovascular disease; CVD, cardiovascular disease
Figure 1
Figure 1. Risk Percentiles of 10-year ASCVD Risk
Cardiovascular disease risk percentiles of 10-year ASCVD risk age 45, 55, 65, and 75 in United States adults free of CVD, grouped by: a) non-black males; b) black males; c) non-black females; and d) black females. ASCVD indicates atherosclerotic cardiovascular disease; CVD, cardiovascular disease
Figure 1
Figure 1. Risk Percentiles of 10-year ASCVD Risk
Cardiovascular disease risk percentiles of 10-year ASCVD risk age 45, 55, 65, and 75 in United States adults free of CVD, grouped by: a) non-black males; b) black males; c) non-black females; and d) black females. ASCVD indicates atherosclerotic cardiovascular disease; CVD, cardiovascular disease
Figure 1
Figure 1. Risk Percentiles of 10-year ASCVD Risk
Cardiovascular disease risk percentiles of 10-year ASCVD risk age 45, 55, 65, and 75 in United States adults free of CVD, grouped by: a) non-black males; b) black males; c) non-black females; and d) black females. ASCVD indicates atherosclerotic cardiovascular disease; CVD, cardiovascular disease
Figure 2
Figure 2. Proportion of CVD-free Adults Meeting or Exceeding 10-year ASCVD Risk
Proportion of CVD-free adults at each age meeting or exceeding a 10-year ASCVD risk of ≥7.5%. ASCVD indicates atherosclerotic cardiovascular disease; CVD, cardiovascular disease
Figure 3
Figure 3. Online 10-year ASCVD Risk to Cardiovascular Risk Percentile Conversion Tool
Screen capture of online tool converting 10-year ASCVD risk into cardiovascular risk percentile ASCVD indicates atherosclerotic cardiovascular disease
See this image and copyright information in PMC

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