New Tool Brings Big Changes to Cardiovascular Disease Predictions

The new tool evaluates the risk of heart attack, stroke and – for the first time in such a calculator – heart failure.

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Experts have unveiled a new tool to predict a person's long-term risk of cardiovascular disease, one that includes broader measures of health and provides sex-specific results but leaves out considerations of race.

The new tool, or risk calculator, evaluates the risk of heart attack, stroke and – for the first time in such a calculator – heart failure. It also factors in new measures of cardiovascular disease, kidney disease and metabolic disease, which includes Type 2 diabetes and obesity.

Compared with the existing calculator, the new version allows health professionals to evaluate younger people and look further into the future.

Details about the calculator were published Friday in the journal Circulation as a scientific statement from the American Heart Association alongside a paper detailing the development, testing and formulas for the new tool. The new AHA risk calculator will help doctors evaluate health risks and may help people receive care earlier to reduce them, Dr. Sadiya S. Khan, chairperson of the committee that wrote the statement, said in a news release.

A risk calculator allows a health care professional to use health data, such as blood pressure and cholesterol levels, as well as demographic and socioeconomic information to produce a risk estimate or score. The new equations were developed using data from more than 6 million U.S. adults from a variety of racial and ethnic, socioeconomic and geographic backgrounds.

The new calculator incorporates cardiovascular-kidney-metabolic syndrome, which was first defined by the AHA in October. CKM syndrome comes in five stages; people with it are at higher risk of heart attack, stroke or heart failure with each stage. The risk increases as the underlying conditions of CKM syndrome worsen. According to AHA statistics, 1 in 3 U.S. adults has three or more risk factors that contribute to the syndrome.

The new calculator is called PREVENT, which stands for Predicting Risk of cardiovascular disease EVENTs. An online tool is being developed.

The previous cardiovascular disease risk calculator, the Pooled Cohort Equation, was released in 2013. But new treatments have since become available for conditions such as obesity, Type 2 diabetes and kidney disease, Khan said.

"A new cardiovascular disease risk calculator was needed, particularly one that includes measures of CKM syndrome," Khan said. She is a preventive cardiologist at Northwestern Medicine and an associate professor at Northwestern University's Feinberg School of Medicine, both in Chicago.

In addition to blood pressure and cholesterol levels, the new calculator incorporates measures of blood sugar and kidney function. It also asks about tobacco use and whether people take medications, and it factors in a person's age and sex.

The new calculator can assess people from ages 30 to 79 and can predict risk for heart attack, stroke and heart failure over the next 10 years and 30 years. The previous calculator was designed for people starting at age 40 and looked only 10 years ahead.

"Longer-term estimates are important because short-term or 10-year risk in most young adults is still going to be low. We wanted to think more broadly and apply a life-course perspective," Khan said. "Providing information on 30-year risk may reveal earlier opportunities for intervention and prevention efforts in younger people."

The new calculator distinguishes risks for each biological sex. Although there are clear racial and ethnic disparities in risk factors and in the incidence of cardiovascular disease, the new calculator does not include race in its equations. The AHA statement acknowledges race as a social factor and not a biological variable, meaning it is not a valid factor for predicting risk.

However, PREVENT has an option to include an index that incorporates measures such as education, poverty, unemployment and factors based on a person's environment, and the new calculator has similar accuracy among racial and ethnic groups.

Khan called the new equations "a critical first step toward including CKM health and social factors in risk prediction" for cardiovascular disease.

"The Pooled Cohort Equations were developed with data from only white and Black adults and had separate equations for people of each race," Khan said. "There was not a risk model for individuals from other race and ethnicity groups, so we likely were not accurately estimating risk in many people."

"We also acknowledge that racism, and not race, operates at multiple levels to increase risk" for cardiovascular disease, Khan said, and that more research is needed to determine the factors that underlie racial differences in risks and outcomes.

The new calculator also includes a measure for predicting heart failure, a condition in which the heart can't pump well. Among people with obesity, Type 2 diabetes or kidney disease, the risk for heart failure can be higher than the risk for heart attack or stroke.

Khan said PREVENT's estimates "should prompt conversations between health professionals and patients to increase awareness of CKM health status and CVD risk, and to translate that awareness into actions that improve health and reduce risk." Such actions could include lifestyle changes such as engaging in physical activity and eating healthy foods. They also could include medications, if appropriate.

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