Heart disease remains one of the leading causes of death among American adults, and recent research predicts it will get worse.
Researchers estimate that 51% of Americans will have high blood pressure in 2020. By 2050, that number is expected to rise to 61%, with Blacks, Hispanics, and other communities of color bearing the disproportionate toll. Related health spending is also expected to soar to more than $1.8 trillion.
Clinicians who want to detect heart disease early often rely on mathematical formulas that help predict a person’s likelihood of having a heart attack or stroke within the next 10 years.
Last year, researchers developed a new equation called Predicting the Risk of Cardiovascular Disease Events (PREVENT). The equation takes into account variables such as a person’s medical history and zip code, and can provide a perspective on social factors that influence heart disease risk. The output of the equation helps doctors decide whether to prescribe preventive medications, such as statins for cholesterol or drugs to treat diabetes and high blood pressure. However, the American Heart Association is still evaluating the evidence and has not formally incorporated the new calculator into its treatment guidelines.
Still, as new calculators begin to be tested and used, journalists will be looking at this topic to find story ideas about how PREVENT could change trends in prescribing patterns, health care costs, and heart disease disparities. can.
PREVENT Model details
Rather than relying on race or ethnicity as a proxy for a person’s social situation, researchers used PREVENT to reduce the rate of increase in heart disease by more accurately considering social risk factors. Created.
Sadiya Khan, a cardiovascular epidemiologist at Northwestern University who helped develop the PREVENT calculator, says new models like PREVENT are needed because they are built using the latest scientific evidence about risk factors for heart disease. It’s because I’m here. “When we use models to inform clinical practice, we need to make sure these models are accurate,” said Khan to discuss the use of race in clinical algorithms. said at a June 21 meeting at the National Academy of Medicine.
problem
Since 2013, the American Heart Association has recommended that clinicians use the pooled cohort equation (PCE) to assess heart disease risk. Although the equation was created from a diverse population, it yielded separate answers for black and white men and women. Racial corrections were not the only concern. In a 2015 analysis, researchers found that this equation overestimated the risk of atherosclerotic cardiovascular disease by approximately 86% in a multiethnic cohort.
raceless equation
Researchers developed the new PREVENT model using health data from a diverse population of more than 3 million people representing different races and ethnicities. They tested the equation with data from different populations.
Instead of race, the researchers used a measure called the Social Deprivation Index (SDI). The SDI reflects geographic location and other neighborhood circumstances that can determine the discrimination a person is likely to experience. An equation that combines variables such as a person’s kidney function, cholesterol, and other markers of heart disease gives clinicians an estimate of that person’s 10- and 30-year risk of serious heart disease.
Estimating the impact
In a paper published this year, researchers calculated how using PREVENT’s equation could change the care of millions of Americans with heart disease. The research team used data from 7,765 adults ages 30 to 79 who participated in the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2020, and found that the PREVENT calculator predicted cholesterol and blood pressure medication prescriptions in this cohort. We evaluated how to change the
Using this equation means fewer people are eligible for both types of drugs. 14.3 million fewer people met the criteria for statins to treat high cholesterol, and 2.62 million fewer people met the criteria for antihypertensive drugs. This change was more likely to affect men than women, and it was more likely to affect black adults than white adults. These changes could lead to “an estimated 107,000 additional myocardial infarctions or strokes” over 10 years, the researchers wrote.
In total, about half of American adults are at low risk for some types of heart disease, the study reported.
Further context
The PREVENT calculator has not yet been formally incorporated into treatment guidelines. The July study results also depend on existing thresholds at which statins or antihypertensive drugs are prescribed. As researchers and clinicians better understand heart disease risk, these numbers can also be updated to better match the output of the PREVENT calculator. When reporting on prescription changes or the unequal burden of changes between different races, adding this context can help readers understand how the calculator impacts their health.
additional resources
Source link
