Refining ASCVD risk prediction and temporal trends: the role of chronic kidney disease, polygenic risk scores, and longitudinal studies.

Abstract

We read with pleasure the article by Chobufo et al.,1 titled ‘Temporal trends in atherosclerotic cardiovascular disease risk among U.S. adults. Analysis of the National Health and Nutrition Examination Survey, 1999–2018’ and would like to highlight the potential benefits of supplementing the Pooled Cohort Equations (PCE) with additional measures, as well as the potential value of incorporating a longitudinal study design into population-based atherosclerotic cardiovascular disease (ASCVD) risk assessment. Chobudo et al. utilized the National Health and Nutrition Examination Survey (NHANES) to assess trends in estimated ASCVD risk using PCE in the US adult population between 1999–2000 and 2017–2018. The study found that there was a decline in ASCVD risk over time, but the trend was non-linear. Additionally, there was a reduction in low-density lipoprotein cholesterol (LDL-C) levels and in the prevalence of smoking, but an increase in the mean body mass index (BMI) and the prevalence of diabetes mellitus. ASCVD risk was higher in men compared to women and in non-Hispanic Black participants compared to non-Hispanic White participants. Participants with a family income below three times the poverty threshold had higher ASCVD risk compared with those with a higher family income. The study also found that after a significant decline in ASCVD risk between 1999–2000 and 2011–2012, there was no further reduction in ASCVD risk from 2013–2014 to 2017–2018. The study suggests that interventions to reduce the prevalence of smoking, diabetes, and hypertension, and to address issues of affordability and access to preventive care may be necessary to improve ASCVD risk in specific populations.