• J Gen Intern Med · Jun 2020

    The Accuracy of Cardiovascular Pooled Cohort Risk Estimates in U.S. Older Adults.

    • Michael G Nanna, Eric D Peterson, Daniel Wojdyla, and Ann Marie Navar.
    • Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, 27710, USA. michael.nanna@duke.edu.
    • J Gen Intern Med. 2020 Jun 1; 35 (6): 1701-1708.

    BackgroundThe ACC/AHA guidelines for primary prevention rely on the Pooled Cohort Risk Equations (PCE) risk estimates of atherosclerotic cardiovascular disease (ASCVD) to guide treatment decisions. In light of the PCE being derived in younger populations, their accuracy in older adults is uncertain.ObjectiveTo evaluate the predictive accuracy and calibration of the PCE in older individuals.Design And SettingWe estimated CVD predicted and observed risk among individuals from four large prospective cohort studies: Cardiovascular Health Study, Multiethnic Study of Atherosclerosis, Framingham Original, and Framingham Offspring.Participants12,527 overall individuals without ASCVD, including 9864 individuals aged 40-74 years and 2663 aged ≥75 years.MeasurementsWe examined the operating characteristics of the PCE to estimate 5-year risk of stroke, MI, and CHD death overall and by age and sex strata. The associations between individual components of the PCE and cardiovascular events by age group (≥75 vs 40-74 years) were also evaluated.ResultsThe PCE had low discrimination for 5-year ASCVD risk in older (≥75 years) (c-statistic = 0.62, 95% CI 0.60-0.65) vs. younger (40-74 years) adults (c-statistic = 0.75, 95% CI 0.73-0.76). Calibration of the PCE was suboptimal in both older and younger adults, overestimating risk in the highest risk groups. Performance of the PCE in older adults was similarly poor when stratified by sex and age ≥ 80 years.LimitationsSince the PCE were derived from similar cohorts, though using different age groups and exams, this analysis likely overestimates the performance of the PCE.ConclusionThe performance of the PCE for ASCVD risk estimation in older adults is suboptimal; new models to effectively risk-stratify older adults are needed.

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