Performance of the Pooled Cohort Equations in Hispanic Individuals Across the United States: Insights From the Multi‐Ethnic Study of Atherosclerosis and the Dallas Heart Study
Year: 2021
Type: article
Abstract: lthough atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death among US Hispanic individuals, there is no validated Hispanic ASCVD risk assessment tool. 1 Current guidelines recommend the non-Hispanic White pooled cohort equation (PCE) for 10-year ASCVD risk estimation among Hispanic individuals, while the non-Hispanic Black PCE is recommended when African ancestry is present. 1 The performance of this approach is unknown, and there is no guidance on its clinical implementation.We evaluated the PCE performance among participants from 2 contemporary, population-based, multi-ethnic US cohorts: the DHS (Dallas Heart Study; ages 18-65 years) and the MESA (Multi-Ethnic Study of Atherosclerosis; ages 45-84 years).2,3 Informed consent was obtained, and institutional review boards approved both studies.Participants were stratified by self-reported race of non-Hispanic White, non-Hispanic Black, and Hispanic individuals.MESA Hispanic individuals were stratified by self-reported heritage into a group consisting of Mexican and Central and South American individuals and another consisting of Puerto Rican, Dominican, and Cuban individuals based on hypothesized African ancestry.The DHS did not include Hispanic heritage group classification.We included participants aged 40 to 75 years without prior ASCVD or diabetes mellitus, with low-density lipoprotein cholesterol 70 to 189 mg/dL who were followed for incident adjudicated ASCVD events: fatal and nonfatal myocardial infarctions, strokes, or coronary heart disease deaths. 2 We excluded participants with baseline statin use or missing PCE data.Data will not be made available for purposes of reproducing the results.We assessed risk discrimination using c-statistics reflecting the area under the receiver operating characteristic curve.We compared mean 10-year PCEpredicted ASCVD incidence to observed 10-year ASCVD events across baseline 10-year risk categories: <5%, 5% to <7.5%, 7.5% to <20%, and ≥20%.We assessed calibration by predicted-to-observed risk (P/O) ratios using the Grønnesby-Borgan goodnessof-fit test with an ideal P/O ratio of 1.We compared P/O ratios using unpaired t-tests.We estimated 95% CI for c-statistics and P/O ratios by dropping the 2.5% smallest and largest values from 1000 sorted nonparametric bootstrap estimates.As an exploratory analysis, we compared risk discrimination using both non-Hispanic White and non-Hispanic Black PCEs among MESA Hispanic heritage groups described
Institutions: Duke Medical Center, Duke University Hospital, Emory University, The University of Texas Southwestern Medical Center, Yale New Haven Hospital, Yale University, Albert Einstein College of Medicine, Fred Hutch Cancer Center, Johns Hopkins University, Houston Methodist, Montefiore Medical Center
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,025
Awards: MESA, G1409423729, G1686417863, G2262782284, MESA, Clinical and Translational Science Award, Institute for Clinical and Translational Research (UL1), MESA, SUBCLINICAL CARDIOVASCULAR DISEASE STUDY--EBCT READING, G3647016462, G3687594596, MESA, G399481048, TITLE: MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS (MESA), G4512137732, OPTION 3. 4/1/2014 - 3/31/2015. MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS (MESA) - READING CENTER, NHLBI, MESA, G5088122703, G5108002584, SUBCLINICAL CARDIOVASCULAR DISEASE STUDY-ULTRASOUND, G5787256936, G6095866717, G6359107525, MESA, G6514094751, MESA
OpenAlex ID: W3152642759