Abstract 424: An Automated Estimated Atherosclerotic Cardiovascular Disease Risk Score

Abstract

Background: Calculating Atherosclerotic Cardiovascular Disease (ASCVD) risk is a key step in CVD prevention, but that standard approach requires risk factor data and use of a computer. Objective: To develop a simplified ASCVD risk score automatically calculated by the clinical laboratory from a standard lipid panel. Methods: Using data from 6,027 participants (excluding those with diabetes or on lipid lowering drugs) from the National Health and Nutrition Examination Survey (NHANES), we developed regression equations to generate an eASCVD risk score that provides estimates similar to standard ASCVD score in 4 race/sex groups: Non-Hispanic Whites men (NHWM) or women (NHWW) and Black men (BM) or women (BW), using TC, HDL-C, TG, and age. The new eASCVD score was externally validated in the Atherosclerosis Risk In Communities (ARIC) (N=14,742) study and compared to the standard ASCVD risk score for its association with clinical ASCVD events (N=14,742). Results: The eASCVD risk score had a sensitivity of 69% and a specificity of 97.5% for identifying statin-eligible patients with at least intermediate risk by the standard risk score at a cutpoint of 7.5%/10-year. By using the sum of the presence of non-lipid risk factors (SBP>130 mmHg, blood pressure medications and smoking) to adjust the threshold of the eASCVD risk score, its overall sensitivity increased to 94%, with a specificity of 92%. For each race/gender group, the eASCVD risk score performed similarly, but the positive predictive value (PPV) for men was better (88.6% for NHWM and 88.7% for BM) than for women (79% for NHWM and 78.7% for BW). Finally, eASCVD risk score showed 90% agreement with the standard risk score in predicting CVD events in the ARIC study. Conclusions: The eASCVD risk score can be automatically calculated by the clinical laboratory from a standard lipid panel. It identifies the majority of statin-eligible patients and can be used as a decision aid for statin therapy.