Abstract P021: Performance Of Pooled Cohort Equations And MESA Risk Score Across Race/Ethnicity And Socioeconomic Status To Estimate 10-year Cardiovascular Risk In Diverse New England Cohort

Abstract

Introduction: The Pooled Cohort Equations (PCE) are the clinical standard for risk estimation of 10-year ASCVD risk, but they have not been extensively validated in minority populations or compared with newer risk estimation calculators such as the Multi-Ethnic Study of Atherosclerosis (MESA) 10-year CHD risk score. Methods: We collected 20-year electronic medical record data (1997-2017) from 34,138 patients in New England (age range in 2007: 55-75). These patients were not on statins and had no documented ASCVD event between 1997 and 2007. Cardiovascular risk factors were collected to calculate PCE and MESA (excluding coronary calcium) scores in 2007. 10-year incident ASCVD events were recorded using ICD codes (2007-17). Risk estimates were evaluated in the total population, race/ethnicity subgroups, and by socioeconomic status (SES) (quintiles of median community income). Results: Overall, PCE and MESA scores had similar discriminative performance (c-statistic: 0.69 vs. 0.70, p-value = 0.15). Both PCE and MESA scores had the best discriminative performance in whites and among individuals with top quintile SES relative to other racial and SES subgroups. In whites, MESA scores had better discriminative performance than PCE (c-statistic: 0.71 vs. 0.70, p-value = 0.005). PCE had higher discriminative performance for African Americans, Hispanics, and Asians but was not statistically significant. PCE and MESA scores had similar calibration metrics for whites but had differing degrees of calibration in African Americans (O to E: 0.79), Hispanics (O to E: 0.83), and Asians (O to E: 0.95) compared with MESA scores (O to E: African Americans: 1.17, Hispanics: 0.96, Asians: 1.51). Conclusion: While MESA and PCE have similar trends in discriminative performance across race/ethnicity and SES, they differed in calibration across minority groups. Clinicians should be cognizant of model performance differences across racial/ethnic and SES subgroups when using risk scores for determining preventive therapies such as statins.