ACC 2015: Newer heart risk calculator may better account for racial differences

Woodruff Health Sciences Center | March 17, 2015

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Quinn Eastman
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A newer risk calculator may estimate subclinical vascular disease in African American populations better than the Framingham Risk Score, Emory cardiology researchers say.

A risk calculator for cardiovascular disease, developed as a companion for the 2013 American College of Cardiology/American Heart Association cholesterol guidelines, may account for racial differences in sub-clinical vascular function better than the Framingham Risk Score, Emory cardiology researchers say.

Their findings were presented Monday at the American College of Cardiology meeting in San Diego.

African Americans, especially men, tend to have a higher prevalence of cardiovascular disease, but this differences are not reflected in the Framingham Risk score. Arterial stiffness is a sign of heart disease risk that tends to appear more prominently among African Americans than whites. Cardiovascular research fellow Jia Shen, MD, MPH, and Emory colleagues analyzed data on arterial stiffness and structure from 1235 people – 777 whites and 458 African-Americans -- enrolled in two large studies (Center for Health Discovery and Well Being and META-Health).

Statistically, racial differences in arterial stiffness and carotid wall thickness persisted after adjustment with the Framingham Risk Score, but were no longer significant after adjustment with the ACC/AHA risk calculator.

"Our findings suggest that the ACC/AHA risk calculator may better estimate subclinical vascular disease in the African American population," Shen says.

The Framingham Risk Score, based on long-term studies on the population of that mostly white Massachusetts town, has been a mainstream tool for heart disease risk calculation. The ACC/AHA risk estimator is based on data from multiple community-based populations and was designed to be more applicable to African-Americans.

To calculate both risk scores, it is necessary to know a patient's age and sex, smoking history, whether diabetes is present, total and HDL cholesterol, and blood pressure. Although both have the primary purpose of predicting someone's risk of major heart disease events such as a heart attack, the team's findings show that the ACC/AHA score may be helpful in probing aspects of subclinical disease such as arterial stiffness as well.

Senior authors are Arshed Quyyumi, MD, co-director of Emory's Clinical Cardiovascular Research Institute, and Laurence Sperling, MD, director of Preventive Cardiology at the Emory Clinic and co-director of Emory's Cardiovascular Disease Fellowship Program.