Discordance between 10-year cardiovascular risk estimates using the ACC/AHA 2013 estimator and coronary artery calcium in individuals from 5 racial/ethnic groups

Comparing MASALA and MESA

Mahmoud Al Rifai, Miguel Cainzos-Achirica, Alka M. Kanaya, Namratha R Kandula, Zeina Dardardi, Parag H. Joshi, Jaideep Patel, Matthew Budoff, Joseph Yeboah, Eliseo Guallar, Roger S. Blumenthal, Michael J. Blaha

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background and aims: South Asian (SA) individuals are thought to represent a group that is at high-risk for atherosclerotic cardiovascular disease (ASCVD). However, the performance of the Pooled Cohort Equations (PCE) remains uncertain in SAs living in the US. We aimed to study the interplay between predicted 10-year ASCVD risk and coronary artery calcium (CAC) in SAs compared to other racial/ethnic groups. Methods: We studied 536 SAs from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study, and 2073 Non-Hispanic Whites (NHWs), 1514 African Americans (AAs), 1254 Hispanics, and 671 Chinese Americans (CAs) from the Multi-Ethnic Study of Atherosclerosis (MESA) who were not currently on statins. We used logistic regression models to assess the association between race/ethnicity and CAC within each ASCVD risk stratum. Results: SAs at low and at intermediate estimated ASCVD risk were more likely to have CAC = 0 compared to NHWs, while SAs at high risk had a similar CAC burden to NHWs. For example, intermediate-risk SAs had a 73% higher odds of CAC = 0 compared to NHWs (95% 1.00–2.99), while high-risk SAs were equally likely to have CAC = 0 (OR 0.95, 95% CI 0.65–1.38) and CAC >100 (OR 0.86, 95% CI 0.61–1.22). Conclusions: Our results suggest that the extent of ASCVD risk overestimation using the PCEs may be even greater among SAs considered at low and intermediate risk than among NHWs. Studies with incident ASCVD events are required to validate and/or recalibrate current ASCVD risk prediction tools in this group.

Original languageEnglish (US)
Pages (from-to)122-129
Number of pages8
JournalAtherosclerosis
Volume279
DOIs
StatePublished - Dec 1 2018

Fingerprint

Ethnic Groups
Atherosclerosis
Coronary Vessels
Calcium
Cardiovascular Diseases
Logistic Models
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Asian Americans
Hispanic Americans
African Americans

Keywords

  • Atherosclerosis
  • Cardiovascular disease
  • Coronary artery calcium
  • Race/ethnicity
  • Risk
  • South Asian

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Al Rifai, Mahmoud ; Cainzos-Achirica, Miguel ; Kanaya, Alka M. ; Kandula, Namratha R ; Dardardi, Zeina ; Joshi, Parag H. ; Patel, Jaideep ; Budoff, Matthew ; Yeboah, Joseph ; Guallar, Eliseo ; Blumenthal, Roger S. ; Blaha, Michael J. / Discordance between 10-year cardiovascular risk estimates using the ACC/AHA 2013 estimator and coronary artery calcium in individuals from 5 racial/ethnic groups : Comparing MASALA and MESA. In: Atherosclerosis. 2018 ; Vol. 279. pp. 122-129.
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abstract = "Background and aims: South Asian (SA) individuals are thought to represent a group that is at high-risk for atherosclerotic cardiovascular disease (ASCVD). However, the performance of the Pooled Cohort Equations (PCE) remains uncertain in SAs living in the US. We aimed to study the interplay between predicted 10-year ASCVD risk and coronary artery calcium (CAC) in SAs compared to other racial/ethnic groups. Methods: We studied 536 SAs from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study, and 2073 Non-Hispanic Whites (NHWs), 1514 African Americans (AAs), 1254 Hispanics, and 671 Chinese Americans (CAs) from the Multi-Ethnic Study of Atherosclerosis (MESA) who were not currently on statins. We used logistic regression models to assess the association between race/ethnicity and CAC within each ASCVD risk stratum. Results: SAs at low and at intermediate estimated ASCVD risk were more likely to have CAC = 0 compared to NHWs, while SAs at high risk had a similar CAC burden to NHWs. For example, intermediate-risk SAs had a 73{\%} higher odds of CAC = 0 compared to NHWs (95{\%} 1.00–2.99), while high-risk SAs were equally likely to have CAC = 0 (OR 0.95, 95{\%} CI 0.65–1.38) and CAC >100 (OR 0.86, 95{\%} CI 0.61–1.22). Conclusions: Our results suggest that the extent of ASCVD risk overestimation using the PCEs may be even greater among SAs considered at low and intermediate risk than among NHWs. Studies with incident ASCVD events are required to validate and/or recalibrate current ASCVD risk prediction tools in this group.",
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Discordance between 10-year cardiovascular risk estimates using the ACC/AHA 2013 estimator and coronary artery calcium in individuals from 5 racial/ethnic groups : Comparing MASALA and MESA. / Al Rifai, Mahmoud; Cainzos-Achirica, Miguel; Kanaya, Alka M.; Kandula, Namratha R; Dardardi, Zeina; Joshi, Parag H.; Patel, Jaideep; Budoff, Matthew; Yeboah, Joseph; Guallar, Eliseo; Blumenthal, Roger S.; Blaha, Michael J.

In: Atherosclerosis, Vol. 279, 01.12.2018, p. 122-129.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Discordance between 10-year cardiovascular risk estimates using the ACC/AHA 2013 estimator and coronary artery calcium in individuals from 5 racial/ethnic groups

T2 - Comparing MASALA and MESA

AU - Al Rifai, Mahmoud

AU - Cainzos-Achirica, Miguel

AU - Kanaya, Alka M.

AU - Kandula, Namratha R

AU - Dardardi, Zeina

AU - Joshi, Parag H.

AU - Patel, Jaideep

AU - Budoff, Matthew

AU - Yeboah, Joseph

AU - Guallar, Eliseo

AU - Blumenthal, Roger S.

AU - Blaha, Michael J.

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Background and aims: South Asian (SA) individuals are thought to represent a group that is at high-risk for atherosclerotic cardiovascular disease (ASCVD). However, the performance of the Pooled Cohort Equations (PCE) remains uncertain in SAs living in the US. We aimed to study the interplay between predicted 10-year ASCVD risk and coronary artery calcium (CAC) in SAs compared to other racial/ethnic groups. Methods: We studied 536 SAs from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study, and 2073 Non-Hispanic Whites (NHWs), 1514 African Americans (AAs), 1254 Hispanics, and 671 Chinese Americans (CAs) from the Multi-Ethnic Study of Atherosclerosis (MESA) who were not currently on statins. We used logistic regression models to assess the association between race/ethnicity and CAC within each ASCVD risk stratum. Results: SAs at low and at intermediate estimated ASCVD risk were more likely to have CAC = 0 compared to NHWs, while SAs at high risk had a similar CAC burden to NHWs. For example, intermediate-risk SAs had a 73% higher odds of CAC = 0 compared to NHWs (95% 1.00–2.99), while high-risk SAs were equally likely to have CAC = 0 (OR 0.95, 95% CI 0.65–1.38) and CAC >100 (OR 0.86, 95% CI 0.61–1.22). Conclusions: Our results suggest that the extent of ASCVD risk overestimation using the PCEs may be even greater among SAs considered at low and intermediate risk than among NHWs. Studies with incident ASCVD events are required to validate and/or recalibrate current ASCVD risk prediction tools in this group.

AB - Background and aims: South Asian (SA) individuals are thought to represent a group that is at high-risk for atherosclerotic cardiovascular disease (ASCVD). However, the performance of the Pooled Cohort Equations (PCE) remains uncertain in SAs living in the US. We aimed to study the interplay between predicted 10-year ASCVD risk and coronary artery calcium (CAC) in SAs compared to other racial/ethnic groups. Methods: We studied 536 SAs from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study, and 2073 Non-Hispanic Whites (NHWs), 1514 African Americans (AAs), 1254 Hispanics, and 671 Chinese Americans (CAs) from the Multi-Ethnic Study of Atherosclerosis (MESA) who were not currently on statins. We used logistic regression models to assess the association between race/ethnicity and CAC within each ASCVD risk stratum. Results: SAs at low and at intermediate estimated ASCVD risk were more likely to have CAC = 0 compared to NHWs, while SAs at high risk had a similar CAC burden to NHWs. For example, intermediate-risk SAs had a 73% higher odds of CAC = 0 compared to NHWs (95% 1.00–2.99), while high-risk SAs were equally likely to have CAC = 0 (OR 0.95, 95% CI 0.65–1.38) and CAC >100 (OR 0.86, 95% CI 0.61–1.22). Conclusions: Our results suggest that the extent of ASCVD risk overestimation using the PCEs may be even greater among SAs considered at low and intermediate risk than among NHWs. Studies with incident ASCVD events are required to validate and/or recalibrate current ASCVD risk prediction tools in this group.

KW - Atherosclerosis

KW - Cardiovascular disease

KW - Coronary artery calcium

KW - Race/ethnicity

KW - Risk

KW - South Asian

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