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

Jarett R. Beaudoin, MD, MPH; Jill Curran, MS; G. Caleb Alexander, MD, MS

AJPM Focus (Apr 2024)

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

Jarett R. Beaudoin, MD, MPH,
Jill Curran, MS,
G. Caleb Alexander, MD, MS

Affiliations

Jarett R. Beaudoin, MD, MPH: Department of Family and Community Medicine, University of California, Davis, California
Jill Curran, MS: 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
G. Caleb Alexander, MD, MS: 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; Address correspondence to: G. Caleb Alexander, MD, MS, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street W6035, Baltimore MD 21205.

Journal volume & issue: Vol. 3, no. 2
p. 100200

Abstract

Read online

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 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.

Published in AJPM Focus

ISSN: 2773-0654 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Public aspects of medicine
Website: https://www.journals.elsevier.com/ajpm-focus

About the journal

Abstract

Keywords