Abstract 19716: Recommended Use of the Pooled Cohort Equations Over-Estimates Cardiovascular Risk in Hispanics: Evidence from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) and the Multi-Ethnic Study of Atherosclerosis (MESA)
Introduction: The ACC/AHA Pooled Cohort Equations for estimating 10-year atherosclerotic cardiovascular disease (ASCVD) were derived from cohorts of Whites and African Americans, with no representation from Hispanics. Although the ACC/AHA Guideline on the Assessment of Cardiovascular Risk recommends the use of sex-specific Pooled Cohort Equations for non-Hispanic Whites to estimate the risk in Hispanics, this recommendation was based on Expert Opinion. Our goal was to determine whether this recommendation is supported by data from ALLHAT and MESA.
Methods: We identified a total of 4552 Hispanics and 8445 non-Hispanic Whites free of ASCVD at baseline from ALLHAT and MESA. For each gender, a Cox proportional hazards model was fitted to estimate the difference in risk between Hispanics and non-Hispanic Whites after controlling for age, smoking status, history of diabetes, total and HDL-cholesterol, systolic blood pressure and the use of antihypertensive therapy using the coefficients from the Pooled Cohort Equations.
Results: Over a median follow-up of 4.6 years in ALLHAT and 6.7 years in MESA, 245 and 747 ASCVD events were observed in Hispanics and non-Hispanic Whites, respectively. After controlling for risk factors and study-specific effects, we observed lower risk of ASCVD for Hispanics compared to non-Hispanic Whites for both sexes and the differences were statistically significant. The hazard ratios were 0.65 (95% CI: 0.52-0.82) for females and 0.82 (95% CI: 0.68-0.99) for males. In study-specific analyses, hazard ratios for females were similar (0.65 in ALLHAT; 0.66 in MESA). For males, the hazard ratios were 0.76 (95% CI: 0.61-0.95) in ALLHAT and 1.04 (95% CI: 0.71-1.52) in MESA, but the difference between these two estimates was not statistically significant.
Conclusions: Analysis of ALLHAT and MESA data demonstrated that the use of the Pooled Cohort Equations for non-Hispanic Whites over-estimates cardiovascular risk in Hispanics. These findings suggest the need to recalibrate the Pooled Cohort Equations to better predict the risk of ASCVD in Hispanics, particularly for Hispanic women.
Author Disclosures: K. Shum: Consultant/Advisory Board; Modest; Pfizer. Consultant/Advisory Board; Significant; Novartis. P. Zheng: None. T. Dinh: Consultant/Advisory Board; Modest; Good Start Genetics, Bayer HealthCare Pharmaceuticals. Consultant/Advisory Board; Significant; Novartis. C.V. Evans: None. W. Chan: None. E.P. Whitlock: None.
- © 2014 by American Heart Association, Inc.