Approximately 11.8 million US adults originally labelled high-risk for cardiovascular disease (CVD) by the 2013 pooled cohort equations (PCEs) would be relabeled lower-risk using updated equations, according to a study published in the Annals of Internal Medicine.

Multiple studies have indicated that the 2013 PCEs – published by the American College of Cardiology/American Heart Association Task Force on Practice Guidelines – substantially misestimated CVD risk. To investigate the clinical implications of using revised equations, researchers compared outcomes using 2013 PCEs with 2 alternative methods; one used the same derivation method as in 2013 but with updated cohort data, the other changed the derivation method.

Six US cohorts (N=26,689; 40–79 years old without prior CVD) were included in the analysis. For consistency, outcomes were the same as the 2013 PCEs: nonfatal myocardial infarction, death from coronary heart disease, or fatal or nonfatal stroke over a 10-year period.

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The authors found that the 2013 PCEs overestimated the 10-year risk of atherosclerotic CVD by an average of 20% across risk groups. “Misestimation of risk was particularly prominent among black adults, of whom 3.9 million (33% of eligible black persons) had extreme risk estimates (<70% or >250% those of white adults with otherwise-identical risk factor values),” the authors added.  

Revising the PCEs led to be more accurate CVD risk estimates among all races and sex subgroups. Fewer individuals were considered ‘high risk’ based on the updated PCEs, potentially reducing the number of adults recommended statin, aspirin, or blood pressure therapy.

“The revised equations should be further investigated to determine whether they can improve the targeting of CVD therapies by maximizing benefits and minimizing adverse events among patients,” the authors concluded.

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