title: Impact of clinical input variable uncertainties on ten-year atherosclerotic cardiovascular disease risk using new pooled cohort equations.
abstract: Recently released American College of Cardiology/American Heart Association (ACC/AHA) guideline recommends the Pooled Cohort equations for evaluating atherosclerotic cardiovascular risk of individuals. The impact of the clinical input variable uncertainties on the estimates of ten-year cardiovascular risk based on ACC/AHA guidelines is not known.
  
  
  
  Using a publicly available the National Health and Nutrition Examination Survey dataset (2005-2010), we computed maximum and minimum ten-year cardiovascular risks by assuming clinically relevant variations/uncertainties in input of age (0-1 year) and ±10 % variation in total-cholesterol, high density lipoprotein- cholesterol, and systolic blood pressure and by assuming uniform distribution of the variance of each variable. We analyzed the changes in risk category compared to the actual inputs at 5 % and 7.5 % risk limits as these limits define the thresholds for consideration of drug therapy in the new guidelines. The new-pooled cohort equations for risk estimation were implemented in a custom software package.
  
  
  
  Based on our input variances, changes in risk category were possible in up to 24 % of the population cohort at both 5 % and 7.5 % risk boundary limits. This trend was consistently noted across all subgroups except in African American males where most of the cohort had ≥7.5 % baseline risk regardless of the variation in the variables.
  
  
  
  The uncertainties in the input variables can alter the risk categorization. The impact of these variances on the ten-year risk needs to be incorporated into the patient/clinician discussion and clinical decision making. Incorporating good clinical practices for the measurement of critical clinical variables and robust standardization of laboratory parameters to more stringent reference standards is extremely important for successful implementation of the new guidelines. Furthermore, ability to customize the risk calculator inputs to better represent unique clinical circumstances specific to individual needs would be highly desirable in the future versions of the risk calculator.
authors: Department of Medicine, Cardiovascular Disease, University of Alabama at Birmingham, 1808 7th Ave South, BDB 101, Birmingham, AL, 35294, USA. hgupta@uab.edu.|VA Medical Center, Birmingham, AL, USA. hgupta@uab.edu.
authors: Himanshu
authors: H
authors: Gupta
authors: Department of Medicine, Cardiovascular Disease, University of Alabama at Birmingham, 1808 7th Ave South, BDB 101, Birmingham, AL, 35294, USA.
authors: Chun G
authors: CG
authors: Schiros
authors: Department of Medicine, Cardiovascular Disease, University of Alabama at Birmingham, 1808 7th Ave South, BDB 101, Birmingham, AL, 35294, USA.
authors: Oleg F
authors: OF
authors: Sharifov
authors: School of Public Health, The University Of Texas Health Science Centre, Houston, TX, USA.
authors: Apurva
authors: A
authors: Jain
authors: Department of Electrical and Computer Engineering, Auburn University, Auburn, AL, USA.
authors: Thomas S
authors: TS
authors: Denney
mesh_terms: D000328:Adult; D000368:Aged; D000572:American Heart Association; D050197:Atherosclerosis / Q000453:epidemiology*; D003627:Data Interpretation, Statistical; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009749:Nutrition Surveys / Q000379:methods*; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
keywords: Atherosclerosis; Cardiovascular disease; Cholesterol; Computer simulations; Primary prevention; Statins