AHA’s New Risk Calculator Takes Race Out of Heart Disease Predictions

In a groundbreaking development, experts have introduced an advanced tool designed to predict an individual's long-term risk of cardiovascular disease (CVD), according to a news release from the American Heart Association (AHA).¹

This innovative risk calculator, named PREVENT (Predicting Risk of cardiovascular disease EVENTs), not only incorporates traditional health metrics but introduces sex-specific evaluations while omitting considerations of race. The tool assesses the risk of heart attack, stroke, and, for the first time, heart failure (HF), offering a more comprehensive perspective on cardiovascular health. It also takes new measures of CVD, kidney disease, and metabolic disease—including type 2 diabetes and obesity—into account.

“Compared with the existing calculator, the new version allows health professionals to evaluate younger people and look further into the future,” the news release said.

Published in Circulation, the AHA introduced PREVENT alongside a detailed paper outlining its development, testing, and formulas.²

Diverse group holding paper heart | Image credit: Jezper – stock.adobe.com

The equations powering PREVENT were derived from a comprehensive dataset of over 6 million US adults, ensuring representation from diverse racial, ethnic, socioeconomic, and geographic backgrounds. Acknowledging the interconnected nature of cardiovascular-kidney-metabolic (CKM) syndrome—a newly defined condition by the AHA—the calculator factors in its various stages. With each stage, individuals face an escalating risk of heart attack, stroke, or HF. In addition to traditional metrics like blood pressure and cholesterol levels, PREVENT also incorporates measures of blood sugar, kidney function, tobacco use, medications, age, and sex.

Sadiya S Khan, MD, MSc, chairperson of the committee behind the AHA statement, highlighted the tool's potential to empower health care professionals to assess risks more accurately, leading to early interventions that could mitigate cardiovascular risks. Khan is a preventive cardiologist at Northwestern Medicine and associate professor at Northwestern University Feinberg School of Medicine.

Notably, PREVENT recognizes the significance of long-term risk estimation, providing predictions for heart attack, stroke, and heart failure over 10 and 30 years for individuals aged 30 to 79 years. The previous calculator assessed individuals 40 years and older, looking only a decade ahead.

"Longer-term estimates are important because short-term or 10-year risk in most young adults is still going to be low,” Khan said. “We wanted to think more broadly and apply a life-course perspective. Providing information on 30-year risk may reveal earlier opportunities for intervention and prevention efforts in younger people."

Importantly, the tool differentiates risks based on biological sex, acknowledging the unique factors that contribute to cardiovascular health in men and women. However, in a departure from its predecessor, PREVENT excludes race from its equations, recognizing it as a social variable, rather than a biological variable.

“Although there are clear racial and ethnic disparities in risk factors and in the incidence of cardiovascular disease, the new calculator does not include race in its equations,” the AHA news release stated. “The AHA statement acknowledges race as a social factor and not a biological variable, meaning it is not a valid factor for predicting risk.”

However, this does not mean race is being completely ignored. To address social determinants of health, the tool includes an option to incorporate an index considering factors such as education, poverty, unemployment, and environmental influences, and the AHA said the new calculator has similar accuracy among different racial and ethnic groups.

Khan emphasized that these equations represent a crucial first step in integrating CKM health and social factors into CVD risk prediction. Acknowledging the limitations of past models that primarily focused on White and Black adults, she highlighted the need for ongoing research to understand the complex factors contributing to racial differences in cardiovascular risks and outcomes.

"We also acknowledge that racism, and not race, operates at multiple levels to increase risk [for CVD]”, Khan said, noting that more research is needed to identify the exact factors that underlie racial differences in CVD risks and outcomes.

Khan expressed hope that PREVENT's estimates will initiate conversations between health care professionals and patients, fostering awareness of CKM health status and CVD risk. Lifestyle changes, including physical activity and a healthy diet, as well as appropriate medications, could be recommended based on the calculated risk.

References

1. New tool brings big changes to cardiovascular disease predictions. News release. American Heart Association. November 10, 2023. Accessed November 15, 2023. https://www.heart.org/en/news/2023/11/10/new-tool-brings-big-changes-to-cardiovascular-disease-predictions
2. Khan SS, Coresh J, Pencina MJ, et al. Novel prediction equations for absolute risk assessment of total cardiovascular disease incorporating cardiovascular-kidney-metabolic health: a scientific statement from the American Heart Association. Circulation. Published online November 10, 2023. doi:10.1161/CIR.0000000000001191