Abstract 20376: Validation of the 2013 ACC/AHA Pooled Cohort Equation for 10-year Atherosclerotic Cardiovascular Risk Assesment in a Contemporary, Community-Based Historical Cohort
Introduction: The 2013 ACC/AHA Pooled Cohort Equation (AHA Risk Calculator) for atherosclerotic cardiovascular disease (ASCVD) has been shown to accurately predict ASCVD in some cohorts, but its accuracy in contemporary community-based populations with at least 10-year follow up has not been performed.
Hypothesis: We tested the hypothesis that the AHA Risk Calculator will accurately estimate 10-year ASCVD risk in the population.
Methods: Using the Rochester Epidemiology Project (REP) we performed a validation of the AHA Risk Calculator on a community-based cohort of consecutive patients that sought primary care in Olmsted County, MN between the years 1998-2000 and were followed up through March 1st 2016. Inclusion criteria were age 40-79 and complete data to calculate the 10-year risk. We excluded those with known ASCVD, atrial fibrillation or heart failure. Criteria were similar to those used to derivate the AHA Risk Calculator. Events were validated in duplicate and included fatal and non-fatal myocardial infarction (MI) and ischemic stroke. Patient information was ascertained using the record linkage system of the REP. Follow-up was truncated at 10 years. We compared the calculated and observed 10-year ASCVD risk across predefined risk groups and calculated c-statistics using the continuous risk score as the main predictor.
Results: We included 23,629 adults, mean age (SE) 53.7(0.06), 46% males, with a mean follow-up of 16.1(0.01) years. There were 1,237 ASCVD events (5.2%) at 10 years of follow-up in 967 people: 766 non-fatal MI, 255 MI deaths, 161 ischemic strokes and 55 ischemic stroke deaths. The AHA Risk Calculator had a good discriminatory value (C statistic: 0.76), but overestimated the 10-year ASCVD risk at all risk levels and was more pronounced in subjects with an estimated risk >10%.
Conclusions: The AHA Risk Calculator overestimates ASCVD risk in the community. These results have implications for the applicability of current cholesterol guidelines.
Author Disclosures: M. Garcia: None. J. Medina-Inojosa: None. V.K. Somers: None. R. Chaudhry: None. T. Randal: None. S.L. Mulvagh: None. F. Lopez-Jimenez: None.
- © 2016 by American Heart Association, Inc.