ACC/AHA risk algorithm is valid for black adults, negating need for unique calculator

An analysis of the Jackson Heart Study found the American College of Cardiology/American Heart Association (ACC/AHA) cardiovascular disease risk algorithm and the Framingham Risk Score were valid and worked well for black adults.

Lead researcher Ervin R. Fox, MD, MPH, of the University of Mississippi Medical Center, and colleagues published their results online in JAMA Cardiology on Feb. 24.

They mentioned that black adults have a higher risk of MI, congestive heart failure, stroke and peripheral arterial disease compared with non-Hispanic white adults.

The longitudinal, community-based Jackson Heart Study enrolled 5,301 black adults from Hinds, Rankin and Madison counties in Mississippi. This analysis included participants who attended their first examination cycle between September 2000 and March 2004.

The median follow-up period was 9.1 years, and the researchers analyzed data from August 2013 to May 2013.

The researchers evaluated the following cardiovascular disease risk factors: age, sex, body mass index, systolic blood pressure, antihypertensive therapy, diabetes status, ratio of fasting total cholesterol to high-density lipoprotein cholesterol, current smoking status and estimated glomerular filtration rate. They also assessed the following circulating biomarkers: adiposity, neurohormonal activation, inflammation, endothelial function, glycemic control and insulin resistance.

The researchers defined a cardiovascular disease event as the first occurrence of MI, fatal coronary heart disease, congestive heart failure and stroke or incident angina or intermittent claudication between the participants’ first visit and Dec. 31, 2011.

The mean age of participants at baseline was 53 years old, while 64.8 percent of participants were female. Men had higher mean values for all of the risk factors except for age and diabetes status.

During a follow-up period of up to 10 years, 270 participants (166 women and 104 men) had a first cardiovascular disease event. The researchers mentioned that 92 participants had coronary heart disease, 104 participants had congestive heart failure and 75 participants had stroke.

They tested six models that took into consideration standard risk factors, biomarkers amd measures of subclinical disease and chose two for validation. They mentioned that a model that only incorporated standard risk factors and one that incorporated standard risk factors, blood B-type natriuretic peptide and ankle-brachial index had no improvement compared with the ACC/AHA cardiovascular disease risk algorithm and the Framingham Risk Score.

The study had a few limitations, according to the researchers, including that the validation cohorts were small and yielded few events. They also mentioned that additional studies should identify the comparative accuracy of cardiovascular disease prediction models incorporating standard risk factors, blood biomarkers and measures of subclinical disease in other races/ethnicities.

“Previous risk algorithms were developed in predominantly white populations, and validation in black populations has been limited,” the researchers wrote. “Our findings using the [Jackson Heart Study] data in the present study are valuable because they confirm that current [Framingham Risk Score] and ACC/AHA risk algorithms work well in black individuals and are not easily improved on. A unique risk calculator for blacks may not be necessary.”