Abstract 10128: The Impact of Replacing the Pooled Cohort Equation With Other CVD Risk Scores on Atherosclerosis Cardiovascular Disease Risk Assessment: MESA
Introduction: The increase in statin eligibility by the new cholesterol guidelines is mostly driven by the Pooled Cohort Equation (PCE) criterion (≥ 7.5% 10yr. PCE). The impact of replacing the PCE with either the modified Framingham risk score (FRS) or the Systematic COronary Risk Evaluation (SCORE) on ASCVD risk assessment and statin eligibility remains unknown. We assessed the comparative benefits of using the PCE, FRS and SCORE for ASCVD risk assessment in the Multi Ethnic Study of Atherosclerosis (MESA).
Methods: : 4632 out of 6814 participants (mean age 60±10 years, 47% males, 39% whites, 27% blacks) were included in analysis. Area under the curve (AUC) and decision curve analysis (DCA) were used to compare the three risk scores. [DCA is the plot of net benefit versus probability thresholds; Net Benefit = true positive rate - (false positive rate x weighting factor). Weighting factor = Threshold probability/1-threshold probability].
Results: After a median of 10.2 years, 347 (7.5%) ASCVD events (MI, CHD death, fatal or non-fatal stroke) occurred. All three risk scores had acceptable discriminative ability for incident ASCVD events [(AUC (95% CI) PCE: 0.748(0.722-0.774); FRS: 0.732(0.703-0.761) and SCORE: 0.790(0.764-0.816)]. The SCORE had the best net benefit compared with PCE or FRS across all the probability thresholds considered (0-20%). At the 7.5% probability threshold adopted by the new cholesterol guidelines, SCORE identifies 7 additional people not eligible for statins out of 100 persons eligible under the “treating all” approach compared with PCE (43/100 for SCORE vs. 36/100 for PCE; hence 19% reduction) without missing any true high risk person.
Conclusions: At the ACC/AHA recommended 7.5% ASCVD risk threshold, SCORE reduced statin eligibility by 19% compared with the PCE without missing any true high risk person. Validation of our findings in other cohort is needed.
- Decision Curve Analysis
- Risk prediction
- Primary Preventions
- Atherosclerotic Cardiovascular Disease
Author Disclosures: W. Qureshi: None. P. Flueckiger: None. M. Blaha: None. E.D. Michos: None. V. Sandfort: None. D.M. Herrington: None. G. Burke: None. J. Yeboah: None.
- © 2015 by American Heart Association, Inc.