title: Development and Validation of Risk Prediction Models for Cardiovascular Events in Black Adults: The Jackson Heart Study Cohort.
abstract: Cardiovascular risk assessment is a fundamental component of prevention of cardiovascular disease (CVD). However, commonly used prediction models have been formulated in primarily or exclusively white populations. Whether risk assessment in black adults is dissimilar to that in white adults is uncertain.
  
  
  
  To develop and validate risk prediction models for CVD incidence in black adults, incorporating standard risk factors, biomarkers, and subclinical disease.
  
  
  
  The Jackson Heart Study (JHS), a longitudinal community-based study of 5301 black adults in Jackson, Mississippi. Inclusive study dates were the date of a participant's first visit (September 2000 to March 2004) to December 31, 2011. The median (75th percentile) follow-up was 9.1 (9.7) years. The dates of the analysis were August 2013 to May 2015. Measurements included standard risk factors, including age, sex, body mass index, systolic and diastolic blood pressure, ratio of fasting total cholesterol to high-density lipoprotein cholesterol, estimated glomerular filtration rate, antihypertensive therapy, diabetes mellitus, and smoking; blood biomarkers; and subclinical disease measures, including ankle-brachial index, carotid intimal-medial thickness, and echocardiographic left ventricular hypertrophy and systolic dysfunction.
  
  
  
  Incident CVD event was defined as the first occurrence of myocardial infarction, coronary heart disease death, congestive heart failure, stroke, incident angina, or intermittent claudication. Model performance was compared with the American College of Cardiology/American Heart Association (ACC/AHA) CVD risk algorithm and the Framingham Risk Score (FHS) refitted to the JHS data and evaluated in the Atherosclerosis Risk in Communities (ARIC) and Multi-Ethnic Study of Atherosclerosis cohorts.
  
  
  
  The study cohort comprised 3689 participants with mean (SD) age at baseline was 53 (11) years, and 64.8% (n = 2390) were female. Over a median of 9.1 years, 270 participants (166 women) experienced a first CVD event. A simple combination of standard CVD risk factors, B-type natriuretic peptide, and ankle-brachial index (model 6) yielded modest improvement over a model without B-type natriuretic peptide and ankle-brachial index (C statistic, 0.79; 95% CI, 0.75-0.83 [relative integrated discrimination improvement, 0.22; 95% CI, 0.15-0.30]). However, the reclassification improvement was not substantially different between model 6 and the ACC/AHA CVD Pooled Cohort risk equations or between model 6 and the FHS. The models discriminated reasonably well in the ARIC and Multi-Ethnic Study of Atherosclerosis data (C statistic range, 0.70-0.77).
  
  
  
  Our findings using the JHS data in the present study are valuable because they confirm that current FHS and ACC/AHA risk algorithms work well in black individuals and are not easily improved on. A unique risk calculator for black adults may not be necessary.
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson.
authors.forename: Ervin R
authors.initials: ER
authors.lastname: Fox
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson.
authors.forename: Tandaw E
authors.initials: TE
authors.lastname: Samdarshi
authors.affiliation: Department of Medicine, Jackson Heart Study, University of Mississippi Medical Center, Jackson.
authors.forename: Solomon K
authors.initials: SK
authors.lastname: Musani
authors.affiliation: Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Pencina
authors.affiliation: Department of Epidemiology, School of Public Health, Jackson State University, Jackson, Mississippi.
authors.forename: Jung Hye
authors.initials: JH
authors.lastname: Sung
authors.affiliation: Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Alain G
authors.initials: AG
authors.lastname: Bertoni
authors.affiliation: Division of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Xanthakis
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Pelbreton C
authors.initials: PC
authors.lastname: Balfour
authors.affiliation: Division of Cardiovascular Health and Disease, Department of Medicine, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Satya S
authors.initials: SS
authors.lastname: Shreenivas
authors.affiliation: School of Nursing, Howard University, Washington, DC.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Covington
authors.affiliation: Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois.
authors.forename: Philip R
authors.initials: PR
authors.lastname: Liebson
authors.affiliation: Center of Minority Health and Health Disparities, College of Pharmacy, Xavier University, New Orleans, Louisiana.
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Sarpong
authors.affiliation: Division of Geriatrics, Department of Medicine, University of Mississippi Medical Center, Jackson.
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Butler
authors.affiliation: Division of Geriatrics, Department of Medicine, University of Mississippi Medical Center, Jackson.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Mosley
authors.affiliation: Department of Epidemiology, The University of North Carolina at Chapel Hill.
authors.forename: Wayne D
authors.initials: WD
authors.lastname: Rosamond
authors.affiliation: Division of Epidemiology and Community Health, University of Minnesota, Minneapolis.
authors.forename: Aaron R
authors.initials: AR
authors.lastname: Folsom
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: David M
authors.initials: DM
authors.lastname: Herrington
authors.affiliation: Division of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts15Division of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Ramachandran S
authors.initials: RS
authors.lastname: Vasan
authors.affiliation: Cardiovascular Research Institute, Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia.
authors.forename: Herman A
authors.initials: HA
authors.lastname: Taylor
mesh_terms: D000328:Adult; D044383:Black People / Q000235:genetics*; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D005544:Forecasting; D006801:Humans; D008875:Middle Aged; D008922:Mississippi / Q000453:epidemiology; D008962:Models, Theoretical; D015203:Reproducibility of Results; D018570:Risk Assessment; D001741:Black or African American