ACC/AHA Guidelines Overestimate CVD Risk, Argues New Study
the MPR take:
The pooled cohort equations used in the ACC/AHA Guideline on the Assessment of Cardiovascular Risk overestimate cardiovascular risk compared to observed rates from studies using more contemporary data sets, states a new article in JAMA Internal Medicine. Researchers in this study used data from the Women’s Health Study, a nationwide cohort of 27,542 women ages 45–79 who were free of cardiovascular disease, cancer, or other major illness at study entry (between September 1992 and May 1995). Participants completed annual questionnaires on incident myocardial infarction (MI), stroke, cardiovascular deaths, and coronary revascularization procedures until March 2004 for a median of 10.2 years. The average predicted 10-year risk using the ACC/AHA atherosclerotic cardiovascular disease (ASCVD) pooled cohort equations was 3.6% vs. 2.2%, the observed 10-year ASCVD event rate. Adjustment for use of statins and low rates of revascularization had little impact on this discrepancy as well. The authors hypothesize that about 60% more events would be needed to match the risk predicted by the pooled cohort equations in the ACC/AHA guideline. Overall these equations overpredict the rate of cardiovascular disease in at least seven external validation cohorts, highlighting the potential recalibration of the equations using contemporary data sets such as this study.
Importance: While the pooled cohort equations from the recent American College of Cardiology/American Heart Association (ACC/AHA) Guideline on the Assessment of Cardiovascular Risk have overestimated cardiovascular risk in multiple external cohorts, the reasons for the discrepancy are unclear. ...
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