Author + information
- Jamal S. Ranaa,b,
- Grace H. Tabadaa,b,
- Matthew Solomona,b,
- Joan C. Loa,b,
- Marc Jaffea,b,
- Sue Hee Sunga,b and
- Alan S. Goa,b
Background: The accuracy of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) Pooled Cohort Risk Equation for atherosclerotic cardiovascular disease (ASCVD) events across different levels of obesity is not known.
Methods: The target population for consideration of primary prevention with cholesterol-lowering therapy in a large, integrated health care delivery system population was identified in 2008 and followed up through 2013. Analyses excluded those with known ASCVD, diabetes, LDL-C levels <70 or ≥190 mg/dl, prior lipid-lowering therapy use, or incomplete 5-year follow-up. We compared predicted versus observed 5-year ASCVD risk, overall and according to sex and race/ethnicity.
Results: Among 304,731 eligible adults without diabetes between 40 and 75 years of age, 84,284 (27.6%) adults were obese (BMI ≥ 30 kg/m2). Specifically, 51,699 (17%) were in Class I obesity (BMI 30 – 34.9 kg/m2), 20,022 (6.6%) in Class II obesity (BMI 35 – 39.9 kg/m2) and 12,563 (4.1%) in Class III BMI ≥ 40 kg/m2. Within each 5-year predicted ASCVD risk category, observed event rates were similar despite increasing BMI (Figure). Observed 5-year ASCVD risk was substantially lower across all BMI categories (Figure), with poor calibration and moderate discrimination (C statistic: 0.72-76).
Conclusions: In a large, contemporary population, the ACC/AHA Pooled Cohort Risk Equation substantially overestimated actual 5-year risk across all levels of obesity.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Updates on Risk Factors for Cardiovascular Disease
Abstract Category: 32. Prevention: Clinical
Presentation Number: 1187-059
- 2017 American College of Cardiology Foundation