Performance of the Atherosclerotic Cardiovascular Disease Pooled Cohort Risk Equations by Social Deprivation Status.
BACKGROUND
The atherosclerosis cardiovascular disease (ASCVD) Pooled Cohort risk equations have shown different calibration across US populations with varied levels of social deprivation.


RESULTS
We analyzed the calibration and discrimination of the Pooled Cohort risk equations by social deprivation status among 9066 REGARDS (REasons for Geographic And Racial Differences in Stroke) study participants not taking statins for whom ASCVD risk may lead to statin initiation. Patients were aged 45 to 79 years, had no ASCVD or diabetes mellitus, and had a low-density lipoprotein cholesterol level 70 to 189 mg/dL. Social deprivation was defined using 3 indicators: annual household income <$25 000, less than a high school education, and living without a partner. At baseline in 2003-2007, 54.6%, 27.4%, and 18.0% of participants had 0, 1, and 2 or 3 indicators showing deprivation, respectively. From baseline through December 2012, 457 participants developed ASCVD (nonfatal/fatal stroke, myocardial infarction, or coronary heart disease death). Predicted and observed ASCVD incidence per 1000 person-years were 8.02 and 6.23 (95% CI, 5.31-7.31), respectively, among participants with 0 indicators of deprivation (Hosmer-LemeshowP=0.01); 8.05 and 6.61 (95% CI, 5.29-8.24), respectively, with 1 indicator (P=0.09); and 9.83 and 11.40 (95% CI, 9.23-14.05), respectively, with 2 or 3 indicators (P=0.12). The C-index (95% CI) was 0.72 (0.69-0.75), 0.73 (0.69-0.78), and 0.70 (0.65-0.75) among participants with 0, 1, and 2 or 3 indicators of deprivation, respectively. The net reclassification improvement after adding deprivation data to the Pooled Cohort risk equations was modest (0.12; 95% CI, 0.03-0.21).


CONCLUSIONS
The Pooled Cohort risk equations have good calibration among individuals with social deprivation but overestimate ASCVD risk among those with less social deprivation.
Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, AL lcolantonio@uab.edu lisandro.colantonio@fulbrightmail.org.
Lisandro D
LD
Colantonio
Department of Surgery, School of Medicine, University of Alabama at Birmingham, AL.
Joshua S
JS
Richman
Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, AL.
April P
AP
Carson
Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Donald M
DM
Lloyd-Jones
Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, AL.
George
G
Howard
Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, AL.
Luqin
L
Deng
Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, AL.
Virginia J
VJ
Howard
Department of Medicine, Weill Cornell Medical College, New York, NY.
Monika M
MM
Safford
Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, AL.
Paul
P
Muntner
Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO.
David C
DC
Goff
D000368:Aged; D050197:Atherosclerosis / Q000453:epidemiology*; D002318:Cardiovascular Diseases / Q000453:epidemiology; D008078:Cholesterol, LDL / Q000097:blood; D015331:Cohort Studies; D003327:Coronary Disease / Q000401:mortality*; D004522:Educational Status; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007182:Income / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D012923:Social Class; D020521:Stroke / Q000453:epidemiology* / Q000401:mortality; D014481:United States / Q000453:epidemiology
D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
cardiovascular disease; primary prevention; risk assessment; risk factor; socioeconomic position