Ascvd risk calc
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Understanding ASCVD Risk Calculation: Insights from Recent Research
Calibration and Discrimination of ASCVD Risk Scores
Overestimation in Multiethnic Cohorts
Recent studies have highlighted significant overestimation in the prediction of atherosclerotic cardiovascular disease (ASCVD) risk by commonly used risk scores. In a study involving the Multi-Ethnic Study of Atherosclerosis (MESA), the new American Heart Association (AHA) and American College of Cardiology (ACC) ASCVD risk score, along with three older Framingham-based risk scores, were found to overestimate cardiovascular events by 37% to 154% in men and 8% to 67% in women over a 10.2-year follow-up period. This overestimation persisted across different risk levels and was not explained by preventive therapies such as aspirin, lipid-lowering, or antihypertensive treatments.
ASCVD Risk Prediction in Chinese Populations
The China-PAR project developed and validated 10-year ASCVD risk prediction equations specifically for the Chinese population. These equations demonstrated good calibration and discrimination, with C statistics of 0.794 for men and 0.811 for women, outperforming the Pooled Cohort Equations (PCE) used in the ACC/AHA guidelines. This suggests that population-specific risk models may provide more accurate risk assessments.
ASCVD Risk Scores in Special Populations
Erectile Dysfunction and ASCVD Risk
The ASCVD risk score has also been applied in the context of erectile dysfunction (ED). A study found that the ASCVD score could predict arteriogenic ED, which is associated with a higher risk of cardiovascular events. Patients with intermediate or high ASCVD risk scores were more likely to have arteriogenic ED, indicating that the ASCVD score can be a valuable tool in identifying patients at risk for cardiovascular diseases in this subset.
Breast Arterial Calcification and ASCVD Risk
In women, the presence of breast arterial calcification (BAC) on mammograms has been shown to enhance the predictive ability of the ASCVD risk score. Women with BAC had a higher risk of ASCVD, and the inclusion of BAC in risk assessments could improve primary prevention strategies.
Nontraditional Risk Markers
Coronary Artery Calcium (CAC) Score
The addition of nontraditional risk markers such as the coronary artery calcium (CAC) score has been shown to improve the predictive accuracy of the ASCVD risk estimator. In the MESA study, the CAC score modestly improved the discriminative ability of the PCE, while other markers like the ankle-brachial index (ABI) and high-sensitivity C-reactive protein (hsCRP) did not significantly enhance prediction.
ASCVD Risk in Older Adults with Frailty and Multimorbidity
The performance of the PCE in older adults with frailty and multimorbidity has been evaluated, showing good calibration overall. However, miscalibration was noted in high-risk ranges, particularly in those with cardiometabolic conditions or frailty, suggesting the need for tailored risk assessments in these populations.
ASCVD Risk in HIV-Infected Patients
In sub-Saharan Africa, the ASCVD risk score has been used to assess cardiovascular risk in HIV-infected patients. The ASCVD score classified more patients as high-risk compared to the Framingham Risk Score (FRS) and showed similar classification to carotid intima-media thickness (cIMT) measurements, indicating its utility in this population.
Conclusion
The ASCVD risk score is a widely used tool for predicting cardiovascular risk, but its accuracy can vary across different populations and settings. Overestimation of risk is a common issue, particularly in multiethnic cohorts. Population-specific models, the inclusion of nontraditional risk markers, and tailored assessments for special populations can enhance the predictive accuracy and utility of ASCVD risk scores. These improvements are crucial for effective primary prevention and management of cardiovascular diseases.
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