(150) Effect of Race on Classification of Atherosclerotic Risk Using A National Cardiovascular Risk Prediction Tool

Background: It is currently unclear how many individuals would have a clinically significant change in their Atherosclerotic Cardiovascular Disease (ASCVD) score if only they used the American Heart Association/American College of Cardiology (AHA/ACC) equation of the opposite race.

Objectives: To quantify the number of individuals reclassified for primary prevention of cardiovascular disease due to a change in their race alone based on AHA/ACC equation and to characterize the sensitivity of the AHA/ACC equation.

Methods: We conducted a cross-sectional analysis using 2005-2018 National Health and Nutritional Examination Survey (NHANES), a nationally representative survey in the US. We included individuals aged 40 to 75 without a history of cardiovascular events, diabetes, or other high-risk features. We used data from the NHANES interviews and clinical and laboratory examinations to derive the risk factors used in the AHA/ACC equations and race agnostic 2008 Framingham Risk Score (FRS).Risk factors include demographic variables (age, race), clinical variables (blood pressure, diabetes, smoking status, cholesterol level, hypertension treatment). We then compared ASCVD risk scores using the AHA/ACC equation recommended for white or other-raced individuals with that recommended for black individuals, and with FRS .

Results: A total of 2,946 white, 1,361 black, and 2,495 other-race individuals were included in the analysis. Using the AHA/ACC equation, the mean 10-year ASCVD risk was 5.80% (95% confidence interval [CI] 5.54, 6.06) for white individuals, 7.04% (CI 6.69, 7.39) for black, and 4.93% (CI 4.61, 5.24) for other races. When using the AHA/ACC equation designated for the opposite race (white/other race vs black), the mean ASCVD risk score increased 1.02% (CI 0.90, 1.13) for white individuals, decreased by 1.82% (CI -1.67, -1.96) for black individuals, and increased by 0.98% (CI 0.85, 1.10) for other races. When using clinical ASCVD categories of 10%, 16.93% percent of all individuals were reclassified when using the AHA/ACC’s equation designated for the opposite race. When comparing the ASCVD risk score from the AHA/ACC equation for an individuals assigned race with the race-neutral FRS, all race groups had an increase in risk with a mean difference of +3.70% absolute change for white, +2.64% for black, and +3.98% for other-race individuals.

Conclusions: Changing race within a commonly used cardiovascular risk prediction tool results in significant changes in risk classification among eligible white and black individuals in the United States.