Current CVD Guidelines Overestimate Risk

The 2013 pooled cohort equations (PCEs) for estimating cardiovascular risk may actually overestimate the risk for atherosclerotic cardiovascular disease (CVD), new study findings show.

The 2013 PCEs are currently recommended for use in guidelines issued by the American Heart Association and American College of Cardiology. However, according the authors of the new study, these risk equations likely need to be updated.
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For their study, the researchers tested the accuracy of the equations using data from 26,689 adults aged 50 to 79 years without prior CVD from 6 modern US cohorts.

Specifically, they assessed whether the 2013 PCEs could accurately predict the risks of nonfatal myocardial infarction, death from coronary heart disease, and fatal and nonfatal stroke.

Results of the study revealed that the 2013 PCEs overestimated the 10-year risk for atherosclerotic CVD by an average 20% across all risk groups.

Black adults appeared to be affected most by inaccurate risk estimates, with extreme estimates observed in 3.9 million (33%) black participants. Estimates of CVD risk for black participants were often less than 70% or more than 250% of estimates for white adults, despite risk factor values that were otherwise identical.

Ultimately, the researchers found that revised PCEs could likely improve the accuracy of CVD risk estimates. However, they noted, updating the scores using modern data reduced the number of people considered high-risk for CVD, which could have clinical implications.

“Clinicians and patients should consider the potential benefits and harms of reducing the number of persons recommended aspirin, blood pressure, or statin therapy,” the researchers wrote. “Our findings also indicate that risk equations will generally become outdated over time and require routine updating."

—Christina Vogt

Reference:

Yadlowsky S, Hayward RA, Sussman JB, McClelland RL, Basu S. Clinical implications of revised pooled cohort equations for estimating atherosclerotic cardiovascular disease risk [Published online June 5, 2018]. Ann Intern Med. doi:10.7326/M17-3011