Improving Cardiovascular Disease Primary Prevention Treatment Thresholds in a New England Health Care System
Authors' conclusion
Recalibration and personalized treatment thresholds derived within a health system may improve prevention treatment allocation efficiency.
Study context
- Population
- Patients aged 40 to 79 years without prior atherosclerotic cardiovascular disease (ASCVD) or lipid-lowering medication, Mass General Brigham, New England
- Participants
- 160,926 patients
- Exposure
- Original vs recalibrated pooled cohort equation (PCE)
- Outcome
- Performance of original vs recalibrated PCE (calibration, discrimination, reclassification rate, net benefit) for 10-year ASCVD
- Follow-up
- 10 years
Methodological detailselectronic health records, single health care system, EHR 2010 to 2012 and 2020 to 2022
- Electronic health records
- Single health care system
- EHR 2010 to 2012 and 2020 to 2022
Main finding
As reported in the abstract
10-year ASCVD risk prediction
| Group | Observed vs predicted incidence rate |
|---|---|
| Original PCE | 0.13 vs 0.05 |
Original PCE
Observed vs predicted incidence rate0.13 vs 0.05
- ASCVD developed over 10 years
- 20,373 (12.7%)
- Recalibration additionally identified patients with ASCVD events deemed statin-ineligible by original PCE
- 40%
- Optimal net-benefit threshold, women
- ≥24.0% (+23.3%)
- Optimal net-benefit threshold, men
- ≥26.0% (+18.7%)
- Optimal net-benefit threshold, White or other race
- ≥26.0% (+24.7%)
- Optimal net-benefit threshold, Black or African American
- ≥14.0% (+12.5%)
- Greatest sensitivity improvement threshold, Hispanic or Latino and non-Hispanic Black
- ≥12.3%
- Threshold, non-Hispanic Asian or Pacific Islander
- ≥23.6%
Observational data: associations, not effects.
Original publication
Improving Cardiovascular Disease Primary Prevention Treatment Thresholds in a New England Health Care System. JACC Adv. Published 6 September 2024. doi:10.
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