Abstract 13464: Considering Race and Ethnicity in Cardiovascular Risk Assessment

Abstract

Background: Cardiovascular disease (CVD) remains one of the leading causes of mortality in American adults, with disparities among racial and ethnic groups due to differential healthcare access and systemic racism. To better characterize the validity and generalizability of the AHA/ACC’s 2019 guidelines for primary prevention of CVD and 2018 special report on the use of the risk assessment tool for ASCVD, we examined the racial and ethnic composition of the study populations used in the underlying cited works. Methods: We reviewed all the references cited in the guidelines for our primary outcome, inclusion of race and ethnicity information. In addition, data were collected on study design, location (international, US, or both), reported sex/gender of participants, and total participants. We further assessed discussion of race and ethnicity within the articles as: cursory (1-2 sentences), moderate (3-5 sentences), or extensive (>5 sentences). Finally, we pooled the racial distributions for all study populations and compared it to national rates in the US population of 76% White, 14% Black, 6 % Asian, 19% Hispanic. Results: Of the 58 cited articles, 12 (20.6%) reported racial and/or ethnic backgrounds of participants. Of those 12 articles, 7 (12% of total) included cursory discussions of race and ethnicity, while the remaining 5 included no such discussion. Only 3 (5%) reported both race and sex distributions, none of which allowed calculation of race by sex. The pooled racial averages were 20% Black, 1% Asian and 9% other, with 11% identifying ethnicity as Hispanic. Conclusion: The majority of the guideline source data provides no information regarding the racial and ethnic backgrounds of study participants. Studies that do address race and ethnicity show an overrepresentation of white individuals compared to the general US population and provide no data specifically addressing the risk to people who are neither white nor male. This leads to potential underestimation of risks and imprecise risk calculations for non-white populations due to small sample sizes in the original studies. It is crucial to include diverse participant groups in studies at population rates to ensure precise risk calculations, improve CVD prevention, and reduce mortality rates.