_______________________________________ Hyperlipidemias and Atherosclerotic Cardiovascular Disease
DISTRIBUTION OF ESTIMATED 10-YEAR RISK OF FIRST HARD ASCVD EVENT IN ASCVD-FREE NONPREGNANT U.S. POPULATION, 40 TO 79 YEARS OF AGE, BY SEX AND RACE/ETHNICITY a Population Predicted 10-Year Risk of ASCVD Event <2.5% 2.5% to 4.9% 5.0% to 7.4% 7.5% to 9.9% 10.0% to 14.9% 15.0% to 19.9% ≥20.0% Total 33.4% 21.0% 12.7% 7.4% 8.9% 6.3% 10.2% All Races/Ethnicities Men 17.4% 22.7% 15.6% 10.1% 12.1% 8.8% 13.3% Women 48.0% 19.5% 10.0% 5.0% 5.9% 4.1% 7.5% White Race/Ethnicity Men 18.0% 22.4% 15.7% 10.0% 11.7% 8.7% 13.6% Women 47.1% 20.4% 10.7% 5.1% 5.5% 4.1% 7.1% African American Race/Ethnicity Men 1.4% 23.9% 20.6% 11.8% 17.4% 11.1% 13.8% Women 36.5% 18.7% 10.9% 6.5% 9.4% 5.7% 12.3% Hispanic Race/Ethnicity Men 24.0% 22.1% 13.2% 10.6% 11.4% 6.2% 12.6% Women 59.4% 14.5% 7.5% 4.5% 4.9% 3.0% 6.3% Other Race/Ethnicities Men 20.8% 27.1% 11.6% 7.2% 11.5% 12.3% 9.4% Women 59.8% 18.6% 4.4% 1.7% 6.4% 2.4% 6.7% a Data derived by applying pooled cohort equations to National Health and Nutrition Examination Surveys, 2007–2010. Source: [227] Table 8
Data from the Women’s Health Initiative initially appeared to indicate that the pooled cohort equations overestimated the risk of ASCVD, but when event surveillance was improved by data from Centers for Medicare and Medicaid Services, it was found that the equations discriminated risk well [228]. However, because the algorithms may over- or underestimate risk for individual patients, the 2013 AHA/ACC guideline on assessment of cardiovascular risk additionally introduced the clinician-patient risk discussion to facilitate decisions about appropriate therapy. This risk discussion is an integral part of the decision-making process in the 2018 AHA/ACC guideline on the management of blood cholesterol [24; 227]. As stated, the pooled cohort equations estimate risk of hard ASCVD events among patients 40 to 79 years of age who are without pre-existing disease. Because pooled cohort equations are population equations, the estimates and recommendations for therapy should be considered in the context of the patient’s individual circumstances. Patients are considered to be at elevated risk if the pooled cohort equations estimate is ≥7.5% [24].
CLINICAL ASSESSMENT OF RISK ASSOCIATED WITH HYPERLIPIDEMIAS The Framingham Heart Study took the lead in creating risk- prediction equations, and previous guidelines made use of the Framingham risk score algorithm. However, the 2013 Work Group for the guideline on assessment of cardiovascular risk decided against using the Framingham algorithm due to its use of an exclusively White sample population and the limited scope of the outcome (i.e., to determine CHD alone) [227]. Instead, the Group compiled data from five community-based cohorts that were broadly representative of the U.S. population. The final pooled cohorts included participants from several large, racially and geographically diverse, NHLBI-sponsored studies. The Group validated pooled cohort equations that provided sex- and race-specific estimates of 10-year risk of first, hard ASCVD event (i.e., MI and stroke, fatal and nonfatal) for African-American and White men and women 40 to 79 years of age ( Table 8 ). Variables included in the risk equation were age, total cholesterol, HDL, systolic blood pressure, diabetes, and current smoking status [227].
48
MDAK1526
Powered by FlippingBook