Accurately assessing ASCVD risk in distinct Asian and Hispanic subgroups

By Megan Mayerle, PhD

September 3, 2019

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death for men and women in the United States. Though ASCVD is largely preventable, effective prevention requires an assessment of risk for selection of appropriate interventions. When caring for their patients, clinicians often make use of a set of guidelines put out by the American Heart Association and the American College of Cardiology. The current version of these guidelines relies on Pooled Cohort Equations (PCEs), a statistical methodology to assess risk.

However, the current PCE does not include Asian or Hispanics. Therefore, it is possible that this method of assessing risk might not work properly for these, as well as other, racial and ethnic subgroups. When Hispanic and Asian individuals are studied, they are often aggregated into a single group, masking important differences between distinct Hispanic and Asian subpopulations despite the fact that previous studies have indicated that different Hispanic and Asian subgroups have different cardiovascular disease risk and mortality patterns.

Using data from electronic health records, a team of scientists and clinicians led by Stanford Cardiovascular Institute members Doctors Fatima Rodriguez and Latha Palaniappan decided to explicitly test the accuracy of PCEs in predicting ASCVD risk in different Asian and Hispanic subgroups. The researchers' study, which was recently published in the Journal of the American Heart Association, revealed that PCE generally overestimated risk in Hispanic and Asian patients. Furthermore, the degree of overestimation varied significantly within different Asian and Hispanic subgroups. Specifically, the researchers found that the PCE was the most accurate for Korean and Puerto Rican subgroups.

In light of this information, the researchers suggest that clinicians use caution in interpreting risk assessments made using PCEs, since the degree to which the PCE overestimates risk can vary at the subpopulation level.

Fatima Rodriguez, MD, MPH, (Stanford University), Sukyung Chung, PhD, (Palo Alto Foundation Research Institute), Manuel R. Blum, MD, (Stanford, Inselspitel) Adrien Coulet, PhD, 5 , 6 Sanjay Basu, MD, PhD, (Université de Lorraine, Stanford) and Latha P. Palaniappan, MD, MS, (Stanford). Support for this study came from the McCormick Faculty Fellowship from Stanford University School of Medicine and the National Heart, Lung, and Blood Institute, National Institutes of Health (1K01HL144607), the Swiss National Science Foundation (P2BEP3_175289), the National Heart, Lung, and Blood Institute, National Institutes of Health (R01HL126172), the National Institute on Minority Health and Health Disparities (R01 MD007012), The Widen Horizons program of the IDEX “Lorraine Université d'Excellence” (15‐IDEX‐0004) and the Pilot Grant Program of the Stanford Center for Clinical and Translational Research and Education.

Dr. Fatima Rodriguez

Dr. Latha Palaniappan