Evidence map›Paper›PMID 27151343›Full record

ArticleJournal of the American College of Cardiology2016

Accuracy of the Atherosclerotic Cardiovascular Risk Equation in a Large Contemporary, Multiethnic Population.

Jamal S Rana, Grace H Tabada, Matthew D Solomon, Joan C Lo, Marc G Jaffe, Sue Hee Sung, Christie M Ballantyne, Alan S Go

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of the American College of Cardiology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 167 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
167citing papers in PubMed, 6 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

167 citing papers in PubMed, 6 syntheses or guidelines pooled it.

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107 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors.

Jamal S RanaDivision of Cardiology, Kaiser Permanente Northern California, Oakland, California; Division of Research, Kaiser Permanente Northern California, Oakland, California; Department of Medicine, University of California, San Francisco, San Francisco, California.
Grace H TabadaDivision of Research, Kaiser Permanente Northern California, Oakland, California.
Matthew D SolomonDivision of Cardiology, Kaiser Permanente Northern California, Oakland, California; Division of Research, Kaiser Permanente Northern California, Oakland, California; Department of Medicine, Stanford University, Stanford, California.
Joan C LoDivision of Research, Kaiser Permanente Northern California, Oakland, California; Department of Medicine, University of California, San Francisco, San Francisco, California; Division of Endocrinology, Kaiser Permanente Oakland Medical Center, Oakland, California.
Marc G JaffeDepartment of Medicine, University of California, San Francisco, San Francisco, California; Division of Endocrinology, Kaiser Permanente South San Francisco Medical Center, South San Francisco, California.
Sue Hee SungDivision of Research, Kaiser Permanente Northern California, Oakland, California.
Christie M BallantyneSection of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, and Center for Cardiovascular Disease Prevention, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas.
Alan S GoDivision of Research, Kaiser Permanente Northern California, Oakland, California; Department of Medicine, University of California, San Francisco, San Francisco, California; Departments of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California; Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California. Electronic address: alan.s.go@kp.org.

Funding

HMO Research Network Cardiovascular Research NetworkU19HL091179 · NHLBI · KAISER FOUNDATION RESEARCH INSTITUTE · PI GO, ALAN S · 2007 to 2011
$8.7M
NHLBI NIH HHS U19 HL091179
6 · The paper itself

Abstract

backgroundThe accuracy of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) Pooled Cohort Risk Equation for atherosclerotic cardiovascular disease (ASCVD) events in contemporary and ethnically diverse populations is not well understood.

objectivesThe goal of this study was to evaluate the accuracy of the 2013 ACC/AHA Pooled Cohort Risk Equation within a large, multiethnic population in clinical care.

methodsThe target population for consideration of cholesterol-lowering therapy in a large, integrated health care delivery system population was identified in 2008 and followed up through 2013. The main analyses excluded those with known ASCVD, diabetes mellitus, low-density lipoprotein cholesterol levels <70 or ≥190 mg/dl, prior lipid-lowering therapy use, or incomplete 5-year follow-up. Patient characteristics were obtained from electronic medical records, and ASCVD events were ascertained by using validated algorithms for hospitalization databases and death certificates. We compared predicted versus observed 5-year ASCVD risk, overall and according to sex and race/ethnicity. We additionally examined predicted versus observed risk in patients with diabetes mellitus.

resultsAmong 307,591 eligible adults without diabetes between 40 and 75 years of age, 22,283 were black, 52,917 were Asian/Pacific Islander, and 18,745 were Hispanic. We observed 2,061 ASCVD events during 1,515,142 person-years. In each 5-year predicted ASCVD risk category, observed 5-year ASCVD risk was substantially lower: 0.20% for predicted risk <2.50%; 0.65% for predicted risk 2.50% to <3.75%; 0.90% for predicted risk 3.75% to <5.00%; and 1.85% for predicted risk ≥5.00% (C statistic: 0.74). Similar ASCVD risk overestimation and poor calibration with moderate discrimination (C statistic: 0.68 to 0.74) were observed in sex, racial/ethnic, and socioeconomic status subgroups, and in sensitivity analyses among patients receiving statins for primary prevention. Calibration among 4,242 eligible adults with diabetes was improved, but discrimination was worse (C statistic: 0.64).

conclusionsIn a large, contemporary "real-world" population, the ACC/AHA Pooled Cohort Risk Equation substantially overestimated actual 5-year risk in adults without diabetes, overall and across sociodemographic subgroups.

Indexed as

Racial GroupsRisk AssessmentAdultAgedCaliforniaCholesterol, LDLCoronary Artery DiseaseCoronary DiseaseDiabetes MellitusFollow-Up StudiesHumansHydroxymethylglutaryl-CoA Reductase InhibitorsMiddle AgedMyocardial InfarctionPrimary PreventionStrokeCholesterol, LDLHydroxymethylglutaryl-CoA Reductase Inhibitorscardiovasculardiabetes mellituspredictionrace/ethnicityrisk factor

Identifiers

PMID27151343
PMCPMC5097466

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.