Abstract 010: Application Of A Lifestyle-based Score To Predict Cardiovascular Risk In African Americans: The Jackson Heart Study

Abstract

Introduction: Cardiovascular disease (CVD) primordial prevention tools applicable to diverse populations are scarce. Hypothesis: We assessed the hypothesis that the Healthy Heart Score, a lifestyle-based tool to estimate CVD risk, will perform well in estimating CVD risk in an African American population. Methods: The Jackson Heart Study (JHS) is a prospective cohort, community-based study in Jackson, Mississippi that recruited participants between September 2000 and March 2004 (baseline), with a mean follow up of 12 years. A total of 5306 African American were recruited, 3041 individuals free of CVD at baseline were included for the current analysis. CVD incidence was defined as the first occurrence of fatal/non-fatal myocardial infarction (MI), stroke or fatal coronary heart disease (CHD). The Healthy Heart Score is a lifestyle-based CVD risk prediction model based on 9 components: body mass index (BMI), physical activity, cereal fiber, fruit and vegetables, red and processed meat, nuts, sugar and sweetened beverages and alcohol intake. Gender-specific beta coefficients from its derivation cohorts were used to assess the performance of the Healthy Heart Score. Model discrimination was assessed using Harrell′s C-Index for survival data and time dependent Area Under the Curve (AUC). Model calibration was evaluated through calibration plots. Results: A total of 189 CVD events occurred (111 in women and 78 in men, average age at baseline 53.1 (12.7) years). The Healthy Heart Score showed high-moderate discrimination for CVD events (C-statistic 0.75 (95% CI, 0.71-0.78)) but with little improvement over the age-only model. The time dependent AUC analysis showed similar results for CVD events and improved performance in the first year with the complete model (age only: AUC 0.76 (95% CI, 0.65-0.88) vs. Healthy Heart Score 0.78 (95% CI 0.68-0.89)). Both the age-only and Healthy Heart Score models had better performance in participants without diabetes at baseline. The Healthy Heart Score model showed good calibration. Conclusions and Relevance . In African Americans with a high prevalence of clinical CVD risk factors, the Hearty Heart Score does not improve prediction of mid-life CVD events beyond what is obtained by age alone.