The following commentary on the role of race in predicting risk is provided by Keith Churchwell, M.D., president-elect of the American Heart Association, and lead author Sadiya S. Khan, M.D., associate professor of cardiology at Northwestern Medical School in Chicago. Provided by Dr. for her 2023 American Heart Association Scientific Statement on a new predictive equation for absolute risk assessment of overall cardiovascular disease.

DALLAS, March 12, 2024 – When clinicians discuss long-term health with patients, how do they consider a patient’s race to determine their risk for cardiovascular disease, which kills more than 2,500 people a day in the United States? I often struggle with my decision to make a decision. It disproportionately affects underrepresented groups.

This happened at a time when we and other health care professionals are using an important tool to estimate a patient’s 10-year risk of heart disease and stroke. The tool is called the Pooled Cohort Equation (PCE) and was built using data from approximately 25,000 Black and White individuals. PCE has different equations for blacks and whites to account for the higher risk of heart disease and stroke among the black population.

Recently, there has been concern that different equations for blacks and whites may perpetuate harmful stereotypes or lead to inappropriate inferences that race itself has a biological basis or contributes to disease. there is.

There is also growing interest in developing clinical algorithms that are inclusive of and relevant to individuals of all racial and ethnic groups. At the same time, we want to ensure that new assessment tools do not perpetuate inequities in health care or create inferences that racial disparities no longer exist.

The American Heart Association released a new formula in November to estimate people’s 10- and 30-year risk of heart failure, heart attack, and stroke. The need to develop a new risk equation was based on the growing awareness of poor cardiovascular, renal, and metabolic (CKM) health in the United States’ diverse population.of Pprophesy Rcardiovascular disease risk events (prevent^TM) Calculating factors for age, cholesterol, blood pressure, BMI, diabetes, social determinants of health, smoking, and kidney function.

Race was not included as a risk predictor. We understand that many in the medical community question whether removing race from cardiovascular risk assessments is a positive move, especially for Black patients. During development, we had similar concerns that not including race in the model could have unintended consequences for the accuracy and accuracy of the calculator. Race may underpredict risk for groups disproportionately affected by heart disease because it is a proxy for different lived experiences that contribute to different health outcomes, such as experiences of discrimination and structural racism. was not desirable. Decisions about which variables to include in the equation were based on the data and careful evaluation.

Through testing and validation, we have found that the new PREVENT calculator is accurate across people of all races and ethnicities sampled. Other advantages of using PREVENT compared to PCE are:

• Kidney and metabolic health strategies incorporate health components that prioritize specific health needs and help treat conditions impacted by systemic inequalities. Black Americans are more likely to have chronic kidney disease and diabetes, which contribute to their risk of CVD.
• The postcode-based social deprivation index reflects geographic factors on cardiovascular disease risk. Social determinants of health drive racial disparities in CVD, so including them in risk prediction acknowledges this fact.
• Not including race as a predictor serves to emphasize that race is associated with the disease, not the cause of it.

PREVENT is based on data from two large groups of over 3 million people each. One group is responsible for creating the equations and the other group is responsible for validating them. These datasets include people of different races and ethnicities, and equal numbers of women and men. This is much more representative of today’s U.S. population compared to the data used for PCE.

To be clear, more accurate risk calculation tools do not eliminate the unconscious biases and obvious inequities that individuals of certain races and ethnicities experience when seeking health care. More work is needed to address structural racism in health care. As the wave of anti-diversity laws and policies continues, we must remind ourselves that not including race as a predictor does not erase the deeply entrenched effects of systemic racism that exist in health care access and delivery. I would like to emphasize this.

Black people have faced exclusion and disenfranchisement for centuries. The negative health effects of racism, not race itself, are linked to disease risk. Other minority groups, such as Hispanics, Native Americans, and Asians, as well as people who experience adverse social factors such as unstable housing, also face health disparities for the same reasons.

PREVENT is a beginning, the first step toward creating more equitable tools in cardiovascular care that incorporate social determinants of health. For the scientists working on these tools, their efforts are part of a broader effort to identify and eliminate structural racism in health care. Risk estimates will evolve as scientists continue to evaluate prevention and other clinical equations and seek to better understand the effects of social and environmental factors on health. Are there better markers or predictors of the lived experience of being a person of color in America? Are there better ways to measure social influences on health? And, importantly, are there better ways to measure social influences on health? Does the model work? Does it work? Do you function equally well regardless of your status, income, or location?

Three research groups have begun work to answer these last three questions. Thanks to a grant from the Doris Duke Foundation to the American Heart Association, they will spend the next year using data from health care systems across the United States to examine different racial, ethnic, geographic, and sociodemographic We plan to evaluate prevention between groups.

The American Heart Association also encourages health care providers to evaluate and incorporate this data into their practices to identify patients who need early support to prevent heart attack, stroke, and heart failure. Calculators are available at https://professional.heart.org/prevent.

Additional resources:

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About the American Heart Association

The American Heart Association works tirelessly to help the world live longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with thousands of organizations and the power of millions of volunteers, we fund innovative research, advocate for public health and share lifesaving resources. The Dallas-based organization has served as a leading source of health information for nearly a century. heart.org, Facebook, X Or call 1-800-AHA-USA1.

Media inquiries: 214-706-1173

Maggie Francis: 214-706-1382; maggie.francis@heart.org

General inquiries: 1-800-AHA-USA1 (242-8721)

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