When Given a Lemon, Make Lemonade: Revising Cardiovascular Risk Prediction Scores
Authors: Andrew Paul DeFilippis, Patrick Trainor
Journal: Annals of Internal Medicine (2018)

Editorials3 July 2018When Given a Lemon, Make Lemonade: Revising Cardiovascular Risk Prediction ScoresAndrew Paul DeFilippis, MD, MSc and Patrick Trainor, MS, MAAndrew Paul DeFilippis, MD, MScUniversity of Louisville, Louisville, Kentucky (A.P.D., P.T.)Search for more papers by this author and Patrick Trainor, MS, MAUniversity of Louisville, Louisville, Kentucky (A.P.D., P.T.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-1175 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Accurate estimation of cardiac risk is essential to balancing the risks and benefits of preventive therapies. Underestimation of risk results in preventable cardiovascular events, and overestimation results in unnecessary costs and exposure to treatment side effects. In 2013, the American College of Cardiology and American Heart Association published a new risk score for atherosclerotic cardiovascular disease (ASCVD) to guide risk-reducing therapy (1). However, the applicability of these new pooled cohort equations (PCEs) has been questioned because they have been found to overestimate risk (2, 3).Yadlowsky and colleagues evaluated 2 approaches for improving the PCEs: using the same derivation method ...References1. Goff DC, Lloyd-Jones DM, Bennett G, Coady S, D'Agostino RB, Gibbons R, et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129:S49-73. [PMID: 24222018] doi:10.1161/01.cir.0000437741.48606.98 CrossrefMedlineGoogle Scholar2. Ridker PM, Cook NR. Statins: new American guidelines for prevention of cardiovascular disease. Lancet. 2013;382:1762-5. [PMID: 24268611] doi:10.1016/S0140-6736(13)62388-0 CrossrefMedlineGoogle Scholar3. DeFilippis AP, Young R, Carrubba CJ, McEvoy JW, Budoff MJ, Blumenthal RS, et al. An analysis of calibration and discrimination among multiple cardiovascular risk scores in a modern multiethnic cohort. Ann Intern Med. 2015;162:266-75. [PMID: 25686167]. doi:10.7326/M14-1281 LinkGoogle Scholar4. Yadlowsky S, Hayward RA, Sussman JB, McClelland RL, Min YI, Basu S. Clinical implications of revised pooled cohort equations for estimating atherosclerotic cardiovascular disease risk. Ann Intern Med. 2018;169:20-9. doi:10.7326/M17-3011 LinkGoogle Scholar5. Ingram DD, Kleinman JC. Empirical comparisons of proportional hazards and logistic regression models. Stat Med. 1989;8:525-38. [PMID: 2727473] CrossrefMedlineGoogle Scholar6. DeFilippis AP, Young R, McEvoy JW, Michos ED, Sandfort V, Kronmal RA, et al. Risk score overestimation: the impact of individual cardiovascular risk factors and preventive therapies on the performance of the American Heart Association–American College of Cardiology–Atherosclerotic Cardiovascular Disease risk score in a modern multi-ethnic cohort. Eur Heart J. 2017;38:598-608. [PMID: 27436865] doi:10.1093/eurheartj/ehw301 CrossrefMedlineGoogle Scholar7. Humes KR, Jones NA, Ramirez RR. Overview of race and Hispanic origin: 2010. Washington, DC: U.S. Department of Commerce, Economics and Statistics Administration, U.S. Census Bureau; 2011. Accessed at www.census.gov/prod/cen2010/briefs/c2010br-02.pdf on 3 May 2018. Google Scholar8. Gelman A, Carlin JB, Stern HS, Dunson DB, Vehtari A, Rubin DB. Bayesian Data Analysis. 3rd ed. Boca Raton, FL: CRC Pr; 2013. Google Scholar9. Yeboah J, McClelland RL, Polonsky TS, Burke GL, Sibley CT, O'Leary D, et al. Comparison of novel risk markers for improvement in cardiovascular risk assessment in intermediate-risk individuals. JAMA. 2012;308:788-95. [PMID: 22910756] doi:10.1001/jama.2012.9624 CrossrefMedlineGoogle Scholar10. Blaha MJ. The critical importance of risk score calibration: time for transformative approach to risk score validation? [Editorial]. J Am Coll Cardiol. 2016;67:2131-4. [PMID: 27151344] doi:10.1016/j.jacc.2016.03.479 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of Louisville, Louisville, Kentucky (A.P.D., P.T.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-1175.Corresponding Author: Andrew Paul DeFilippis, MD, MSc, 550 South Jackson Street, Louisville, KY 40202; e-mail, [email protected]edu.Current Author Addresses: Dr. DeFilippis: 550 South Jackson Street, Louisville, KY 40202.Mr. Trainor: 580 South Preston Street, Louisville, KY 40202.This article was published at Annals.org on 5 June 2018. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoClinical Implications of Revised Pooled Cohort Equations for Estimating Atherosclerotic Cardiovascular Disease Risk Steve Yadlowsky , Rodney A. Hayward , Jeremy B. Sussman , Robyn L. McClelland , Yuan-I Min , and Sanjay Basu Metrics Cited byProteomics for personalized cardiovascular risk assessment: in pursuit of the Holy Grail 3 July 2018Volume 169, Issue 1Page: 56-57KeywordsAtherosclerosisAtherosclerotic cardiovascular diseaseCardiovascular therapyDisclosureInformation storage and retrievalMedical risk factorsPopulation statisticsRacial and ethnic issuesRisk assessmentsStatistical methods ePublished: 5 June 2018 Issue Published: 3 July 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...