Heart disease remains one of the leading causes of death amongst adults in the U.S., and a recent study projects it will only get worse.
Researchers estimate that 51% of Americans had hypertension in 2020. By 2050, that number is expected to increase to 61%, with a disproportionate toll being borne by Black, Hispanic and other communities of color. Related health care spending is also expected to soar to more than $1.8 trillion.
Clinicians wanting to catch heart disease early often rely on mathematical equations that help predict the chances of a person having a heart attack or stroke within the next 10 years.
Last year, researchers developed a new equation named Predicting Risk of cardiovascular disease EVENTs (PREVENT), which factors in a person’s medical history as well as variables such as their ZIP code, which can offer perspective on the social factors that affect heart disease risk. The equation’s output can help a doctor decide whether to prescribe preventive medicines such as statins for cholesterol or drugs for diabetes or hypertension. However, the American Heart Association is still evaluating evidence and has not officially incorporated the new calculator into treatment guidelines.
Still, as the new calculator starts being tested and used, journalists can watch the topic to find story ideas about how PREVENT changes trends in prescription patterns, healthcare spending, and disparities in heart disease.
More about the PREVENT model
Researchers created PREVENT to curb rising rates of heart disease by accounting for social risk factors more accurately rather than relying on race or ethnicity as a proxy to represent a person’s social circumstances.
New models like PREVENT are needed because they are built using updated scientific evidence on the heart disease risk factors, according to Sadiya Khan, a cardiovascular epidemiologist at Northwestern University who helped develop the PREVENT calculator. “We need to ensure that these models are accurate if we’re using them to inform clinical practice,” Khan said at a June 21 meeting at the National Academy of Medicine to discuss the use of race in clinical algorithms.
The problem
Since 2013, the American Heart Association has recommended that clinicians use the Pooled Cohort Equations (PCE) to gauge heart disease risk. The equations were developed from a diverse pool of people but produced separate answers for Black and white men and women. The race correction was not the only concern. In a 2015 analysis, researchers found that the equation overestimated risk of atherosclerotic cardiovascular disease by about 86% in a multi-ethnic cohort.
A race-free equation
Researchers developed the new PREVENT model using health data from a diverse population of more than 3 million people representing a rich spectrum of race and ethnicity. They tested the equation in data from a different population.
Instead of race, the researchers used a measure called social deprivation index (SDI), which reflects a person’s geographic location and other neighborhood circumstances that can determine the discrimination a person is likely to experience. Together, with variables like a person’s kidney function, cholesterol and other markers of heart disease, the equation gives clinicians an estimate of a person’s 10-year and 30-year risk of serious heart conditions.
Estimating impact
In a paper published this year, researchers calculated how using the PREVENT equation might change care for the millions of Americans with heart disease. The team used data from 7,765 adults between the ages of 30 and 79 who participated in the National Health and Nutrition Examination Surveys (NHANES) between 2011 and 2020 and gauged how the PREVENT calculator would change prescriptions for cholesterol and blood pressure drugs in this cohort.
Using the equation meant fewer people were eligible for both kinds of drugs: 14.3 million fewer met the cutoff for statins to treat high cholesterol, and 2.62 million fewer for anti-hypertensive medicines. The changes were more likely to affect men than women, and also more likely to affect Black adults than white adults. Over a 10-year period, these changes “could result in an estimated 107,000 additional occurrences of myocardial infarction or stroke,” researchers wrote.
Collectively, about half of all American adults would be placed at a lower risk of some kinds of heart disease, the study reported.
Further context
The PREVENT calculator has not yet been officially incorporated into treatment guidelines. The results of the July study also rely on existing cutoffs at which statins or antihypertensives are prescribed. As researchers and clinicians better understand the risk of heart disease, they may also update these numbers to better align with the output of the PREVENT calculator. When reporting on changes in prescriptions or the unequal burden of change amongst people of different races, adding this context can help readers understand how the calculator might impact their health.
Additional resources
- The Evolving Landscape of Cardiovascular Risk Assessment, editorial in JAMA related to the July study.
- Projected Changes in Statin and Antihypertensive Therapy Eligibility With the AHA PREVENT Cardiovascular Risk Equations, study in JAMA about PREVENT’s impact.
