Race and Ethnicity in Cardiovascular Disease Risk Prediction for Multiethnic Populations: Insights From Global Guidelines.

Cardiovascular disease is the leading cause of death worldwide, with certain racial/ethnic groups facing higher risks. Global clinical guidelines for the prevention of cardiovascular disease vary in their approach to addressing racial/ethnic differences among patients. The authors compare the American Heart Association's 2024 PREVENT (Predicting Risk of Cardiovascular Disease Events) equations, the European Society of Cardiology's 2021 Systematic Coronary Risk Evaluation 2 model, and the Singapore-modified Framingham risk score, with a focus on their differing approaches to race and ethnicity. The PREVENT model removes race and ethnicity as a factor, instead incorporating the Social Deprivation Index to address social determinants of health. SCORE2 introduces multiplier factors for different ethnicities, while the Singapore-modified Framingham risk score retains ethnicity as a variable. Race-neutral models such as PREVENT aim to avoid reinforcing race as a biological construct while still accounting for social determinants of health that are highly correlated with race. In Asia, the path toward race-neutral risk prediction begins with strengthening data infrastructure and increasing participation in clinical trials to ensure adequate representation.