Ten‐year atherosclerotic cardiovascular disease (ASCVD) risk prediction models include the pooled cohort equations (PCE) and the Predicting Risk of Cardiovascular Disease Events (PREVENT) models. We evaluated the relative contributions of predictors in these models, along with social determinants and emerging biomarkers.
Yixin Zhang, Ernst J. Schaefer, Hiroaki Ikezaki et al.· Journal of the American Hear...· 0 citations
Background: The American Heart Association (AHA) recently introduced the novel construct of Cardiovascular-Kidney-Metabolic (CKM) Syndrome, but it is unclear how the CKM staging construct applies to young adults and how it may correlate with cardiovascular health (CVH) status and carotid artery health. Methods: In the Future of Families – Cardiovascular Health Among Young Adults (FF-CHAYA) Study, we defined CKM stages using the AHA’s framework. CVH was measured by Life’s Essential 8 (LE8) scores (composite metric consisting of dietary quality, physical activity, sleep, nicotine exposure, body mass index, blood glycemia, blood lipids, blood pressure). We examined cross-sectional associations of CKM stages with LE8 scores and carotid ultrasonography measures using multivariable regression models adjusted for age, self-identified gender, and self-identified race/ethnicity. Results: Among 1283 FF-CHAYA participants (mean [standard deviation] age 22.9 [0.7] years, 54.4% women), 20.7% of participants were classified as Stage 0 CKM (no risk factors), 40.2% as Stage 1 CKM (excess adiposity), 36.2% as Stage 2 CKM (metabolic risk factors), and 2.8% as Stage 3 CKM (subclinical cardiovascular disease or advanced kidney disease). Compared to Stage 0, participants in Stages 1–3 had significantly lower LE8 scores (beta [95% confidence interval]: −7.6 [−9.4, −5.8] for Stage 1, −13.9 [−15.7, −12.0] for Stage 2, −13.2 [−17.4, −9.0] for Stage 3). Additionally, Stages 1–3 had significantly higher mean-mean and mean-maximum carotid intima-medial thickness (cIMT) and lower grey scale median compared to Stage 0. For example, mean-maximum cIMT was 0.014-mm higher (0.005, 0.020) for Stage 1, 0.020-mm higher (0.017, 0.035) for Stage 2, and 0.100-mm higher (0.085, 0.128) for Stage 3, compared to Stage 0. Conclusion: Among young adults, more advanced CKM stage was associated with worse CVH, including greater evidence of early arterial injury. These findings elucidate the need for earlier preventive efforts and population-level interventions to address upstream drivers of CKM health.
Vaishnavi Krishnan, H. Ning, D. Notterman et al.· Circulation. Population heal...· 0 citations
BACKGROUND
The American Heart Association Predicting Risk of Cardiovascular Disease EVENT (PREVENT) equations were developed from observational research cohorts and electronic health record data and provide sex-specific risk estimates for cardiovascular disease (CVD), atherosclerotic CVD (ASCVD), and heart failure (HF). External validation in large contemporary samples across multiple health systems in the United States is needed.
METHODS
We assembled a national electronic health record-based cohort of US adults with individual-level patient data pooled from a collective of 30 health systems (Truveta) to externally validate the outcome-specific 10-year PREVENT equations (PREVENT-CVD, PREVENT-ASCVD, and PREVENT-HF). We included patients aged 30 to 79 years without a history of prior CVD and with an ambulatory encounter in the electronic health record between 2013 and 2018. The outcomes were defined as total CVD (composite of ASCVD and HF), ASCVD, and HF through December 2024 using diagnosis codes. Model performance of the outcome-specific PREVENT base equations was assessed with the Harrell C statistic and calibration slope, stratified by sex.
RESULTS
Of the 680 864 adults included, the mean (SD) age was 55 (13) years, and 56% were female. Over a mean (SD) follow-up of 6.8 (2.3) years, there were 29 535 incident CVD events, 19 280 incident ASCVD events, and 16 824 incident HF events. The median (interquartile range) 10-year predicted risk of PREVENT-CVD among women was 3.6% (1.3%-8.8%), and among men was 5.8% (2.5%-11.7%). The C statistic (95% CI) was 0.788 (0.786-0.790), and the calibration slope (95% CI) was 0.98 (0.95-1.01) for PREVENT-CVD. PREVENT-ASCVD and PREVENT-HF demonstrated similar C statistics (0.774 [0.771-0.777] and 0.824 [0.820-0.828]) and calibration slopes (1.07 [1.04-1.10] and 1.01 [0.97-1.04]) for prediction of the 10-year risk of ASCVD and HF, respectively.
CONCLUSIONS
The PREVENT equations accurately and precisely estimate the 10-year risk of CVD, ASCVD, and HF in a large sample of US adults. These findings support the generalizability of the PREVENT equations to inform guideline-recommended risk assessment and preventive efforts.
Sadiya S. Khan, Y. Sang, Xiaoning Huang et al.· Circulation. Population heal...· 0 citations
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