Abstract
Background: Atherosclerotic cardiovascular disease (ASCVD) incidence is greater in Hispanic population. Traditional 2013 Pooled Cohort Equation (PCE) models tend to over-predict risks among Veterans by two-fold. Assessment of ASCVD risk with statin therapy has not been extensively investigated in Hispanic Veterans. Objective: We compared 5-year ASCVD incidence of White Hispanic vs White Non-Hispanic Veterans, 18-79 years at baseline in a cohort during 2002-2014. Methods: Ethnicity was determined from census and electronic health data where a Veteran’s last name has a 0.76 positive predictive value for Hispanic ethnicity. We used sex and ethnicity specific Cox models to predict 5-year ASCVD morbidity and mortality. The analyses included PCE variables (age, cholesterol, HDL-C, systolic pressure, blood pressure treatment, smoking, diabetes) plus statin use. Results: A total of 1,383,993 Veterans were in our study with 69,055 (4.9%) females and 81,773 (5.9%) Hispanics. Mean age, cholesterol and HDL-C levels were similar for Hispanics and Non-Hispanics. Smoking, BP therapy, and statin use were less common in Hispanics. Over 5 years of follow-up, 3.9% of Hispanic and 4% of Non-Hispanics developed ASCVD, and 1.3% of Hispanics and 2% of Non-Hispanics experienced ASCVD death. Discrimination of ASCVD events was improved by retraining prediction models using traditional ASCVD risk factors and statin use, with the following concordance statistics: Male Hispanic (0.73), Male Non-Hispanic (0.66), Female Hispanic (0.80), Female Non-Hispanic (0.79). Statin use was associated with a 17% lower ASCVD risk in Hispanics of both sexes and 9% lower ASCVD risk for Non-Hispanics of both sexes. Conclusions and Relevance: Traditional variables plus statin use are efficient predictors of ASCVD morbidity and mortality in a contemporary cohort of Hispanic U.S. Veterans. Baseline statin use was associated with lower risk of ASCVD events in Hispanics compared to Non-Hispanics.
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