Cardiovascular Prediction Tool Underestimated Risk In Poor Socioeconomic Groups Interview with:

Jarrod Dalton PhD Department of Quantitative Health Sciences Cleveland Clinic , Cleveland 

Dr. Dalton

Jarrod Dalton PhD
Department of Quantitative Health Sciences
Cleveland Clinic , Cleveland What is the background for this study? What are the main findings?

Response: Accurate risk assessment is critical for identifying patients who are at high risk of cardiovascular events such as heart attacks and strokes.

We evaluated the performance of a widely-used risk assessment tool against the socioeconomic position of patients’ neighborhoods of residence. This tool, called the Pooled Cohort Equations Risk Model, or PCERM, was developed in 2013 jointly by the American College of Cardiology and the American Heart Association (ACC/AHA).

We found that the PCERM model accurately characterized risk among patients from affluent communities, but performed more poorly among patients from disadvantaged communities. In particular, for these patients, major cardiovascular events occurred at rates that were as much as 2-3 times than predicted from the PCERM model. What should clinicians and patients take away from your report?

Response: Current cardiovascular risk assessment relies on clinical indicators alone. This may be insufficient for accurately characterizing risk, especially for people from socioeconomically disadvantaged communities. “Surrogate” risk factors such as factors associated with an individual’s community of residence may help us better identify high-risk patients. What recommendations do you have for future research as a result of this study?

Response: There are several avenues for future research based on our findings. First, investigating the underlying causes behind increased rates of cardiovascular outcomes among patients from disadvantaged communities is a critical first step toward reducing the expanding disparity in life expectancy across the wealth spectrum. Data from the Brookings Institution suggest that the wealthiest 10% of people now are expected to live over a decade longer than the poorest 10%.

It could be that relationships between clinical indicators and risk of outcome vary across the socioeconomic spectrum. However, there may be additional exposures that increase risk and that are unique to patients from disadvantaged communities. These could include environmental exposures like lead contaminants, air pollutants as well as access to healthy foods, safe places to exercise, and preventive cardiovascular services. Patients from disadvantaged neighborhoods often experience excess stressors over the life course, and there is a developing body of knowledge suggesting that chronic inflammation associated with certain types of stress may be responsible for more advanced coronary heart disease.

Disclosures: This research was funded by the National Institutes of Health. Thank you for your contribution to the community.


Accuracy of Cardiovascular Risk Prediction Varies by Neighborhood Socioeconomic Position A Retrospective Cohort Study
Jarrod E. Dalton, PhD; Adam T. Perzynski, PhD; David A. Zidar, MD; Michael B. Rothberg, MD, MPH; Claudia J. Coulton, PhD; Alex T. Milinovich, BA; Douglas Einstadter, MD, MPH; James K. Karichu, PhD; Neal V. Dawson, MD
Published: Ann Intern Med. 2017.
DOI: 10.7326/M16-2543

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.


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Last Updated on August 30, 2017 by Marie Benz MD FAAD