Prediction of Cardiovascular Death in Racial/Ethnic Minorities Using Framingham Risk Factors

Hurley, Laura P.; Dickinson, L. Miriam; Estacio, Raymond O.; Steiner, John F.; Havranek, Edward P.

doi:10.1161/circoutcomes.108.831073

Cited by 54 publications

(45 citation statements)

References 21 publications

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“…Overall, the Framingham Risk Score calculator can determine a patient's 10-year absolute risk of CHD but may have some limitations and perhaps underestimate the risk in diverse populations [41,42,43]. The strength of associations between individual CVD risk factors differs significantly by race/ethnicity, with a greater risk for CVD mortality at younger ages in some minority individuals, suggesting that CVD risk prediction models should be validated in increasingly diverse, contemporary cohorts [43].…”

Section: Classification Of Race/ethnicity and Cmr: Limitations In Utimentioning

confidence: 99%

Cardiorenal Metabolic Syndrome and Cardiometabolic Risks in Minority Populations

Ferdinand

Rodríguez

Nasser³

et al. 2013

Cardiorenal Med

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Cardiovascular disease (CVD), including heart disease and stroke, is the leading cause of death in the USA, regardless of self-determined race/ethnicity, and largely driven by cardiometabolic risk (CMR) and cardiorenal metabolic syndrome (CRS). The primary drivers of increased CMR include obesity, hypertension, insulin resistance, hyperglycemia, dyslipidemia, chronic kidney disease as well as associated adverse behaviors of physical inactivity, smoking, and unhealthy eating habits. Given the importance of CRS for public health, multiple stakeholders, including the National Minority Quality Forum (the Forum), the American Association of Clinical Endocrinologists (AACE), the American College of Cardiology (ACC), and the Association of Black Cardiologists (ABC), have developed this review to inform clinicians and other health professionals of the unique aspects of CMR in racial/ethnic minorities and of potential means to improve CMR factor control, to reduce CRS and CVD in diverse populations, and to provide more effective, coordinated care. This paper highlights CRS and CMR as sources of significant morbidity and mortality (particularly in racial/ethnic minorities), associated health-care costs, and an evolving index tool for cardiometabolic disease to determine geographical and environmental factors. Finally, this work provides a few examples of interventions potentially successful at reducing disparities in cardiometabolic health.

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Section: Classification Of Race/ethnicity and Cmr: Limitations In Utimentioning

confidence: 99%

Cardiorenal Metabolic Syndrome and Cardiometabolic Risks in Minority Populations

Ferdinand

Rodríguez

Nasser³

et al. 2013

Cardiorenal Med

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“…We have therefore chosen to review a broad range of articles pertinent to racial and ethnic disparities in cardiovascular disease. These include papers examining racial differences in the quality of care provided for patients with myocardial infarction, 11 trends in procedure use for patients with heart failure, 12 survival after heart transplantation, 13 the relative importance of traditional and novel biomarkers of cardiovascular risk, 14 and the influence of socioeconomic factors such as living environment on outcomes. 6 We hope you find these reviews informative.…”

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confidence: 99%

Most Important Articles on Cardiovascular Disease Among Racial and Ethnic Minorities

Mody¹,

Gupta²,

Bikdeli³

et al. 2012

Circ: Cardiovascular Quality and Outcomes

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The following are highlights from the new series, Circulation: Cardiovascular Quality and Outcomes Topic Review. This series will summarize the most important manuscripts, as selected by the Editor, that have published in the Circulation portfolio. The objective of this new series is to provide our readership with a timely, comprehensive selection of important papers that are relevant to the quality and outcomes, and general cardiology audience. The studies included in this article represent the most significant research in the area of cardiovascular disease among racial and ethnic minorities. (Circ Cardiovasc Quality and Outcomes. 2012; 5:e33-e41.) S teady improvements have been made in the management of cardiovascular disease over the last decade.1,2 Yet, certain racial and ethnic minority groups have not experienced equivalent improvements in outcomes. For example, although the overall rate of hospitalization for heart failure has declined in recent years, decreases have been lower in blacks compared with whites. 2In addition, mortality related to stroke continues to be higher in blacks.3 There are multiple potential explanations for this heightened cardiovascular risk among minorities, including their higher prevalence of cardiovascular risk factors such as hypertension, diabetes mellitus, and obesity 4 ; the presence of genetic differences predisposing to disease 5 ; differences in socioeconomic factors relating to education, income, language proficiency, and living environments 6 ; and concerning physician attitudes, biases, or frank racism. 3,7 The Institute of Medicine defines "disparities" as "differences in health outcomes that persist when access and patient clinical factors are controlled." 8 In acknowledging the presence of these disparities experienced by racial and ethnic minorities, the American College of Cardiology (ACC) launched the Coalition to Reduce Racial and Ethnic Disparities in Cardiovascular Disease Outcomes (CREDO) alliance and the American Heart Association (AHA) issued a statement highlighting racial differences in stroke care, among other initiatives.9,10 Through these efforts, the ACC and AHA aim to improve physician awareness of racial disparities in cardiovascular disease care, conduct patient education, and provide tools to health systems to help combat inequalities.There is an urgent need for additional information regarding the pathways mediating racial disparities in cardiovascular care, especially those pathways that are amenable to interventions. We have therefore chosen to review a broad range of articles pertinent to racial and ethnic disparities in cardiovascular disease. These include papers examining racial differences in the quality of care provided for patients with myocardial infarction, 11 trends in procedure use for patients with heart failure, 12 survival after heart transplantation, 13 the relative importance of traditional and novel biomarkers of cardiovascular risk, 14 and the influence of socioeconomic factors such as living environment on outcomes. 6 We ...

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“…This study identified five studies that assessed cardiovascular risk prediction models in cohorts from Latin America or Hispanic populations in the United States (5,18,21,23,24). Overall, evidence supporting the validity of CV prediction rules among these populations is scare.…”

Section: Discussionmentioning

confidence: 99%

“…Data regarding CVD burden and trends among Hispanics living in the United States is also alarming and represents the most likely cause of death among this population (5), about 31% of all deaths (6). The prevalence of heart disease is 8.1% in Hispanics and 12.1% in Caucasians (7) and the prevalence of obesity (8), diabetes mellitus, hypertension, and dyslipidemia, is generally higher among Hispanics than Caucasians (7,9).…”

mentioning

confidence: 99%

Validity of cardiovascular risk prediction models in Latin America and among Hispanics in the United States of America: a systematic review

Cortés-Bergoderi¹,

Thomas²,

Albuquerque³

et al. 2012

Rev Panam Salud Publica

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. MeSH search terms and domains were related to CVD, prediction rules, Latin America (including the Caribbean), and Hispanics in the United States. Database searches were supplemented by correspondence with experts in the field. 1.68 (95% CI, incident myocardial infarction, 1.36 (95% CI, and CHD death, 1.21 (95% CI,. In Ecuador, a prediction model for CVD and total deaths in hypertensive patients had an area under the curve (AUC) of 0.79 (95% CI,, while the World Health Organization method had an AUC of 0.74 (95% CI,. A study predicting mortality risk in people with Chagas' disease had an AUC of 0.81 (95% CI, According to the World Health Organization (WHO), about 25% of all annual deaths in Latin America are due to cardiovascular diseases (CVD) (2, 3). Cardiovascular risk factors, including obesity, hypertension, hypercholesterolemia, diabetes mellitus, and tobacco use are highly prevalent in Latin America and contribute to three-fourths of its CVD cases (4). The prevalence of most, if not all, of these factors has been steadily increasing in recent years in Latin America, and the trend is expected to continue (3). Results. A total of 1 655 abstracts were identified, of which five cohorts with a total of 13 142 subjects met inclusion criteria. A Mexican cohort showed that the predicted/observed event-rate ratio for coronary heart disease (CHD) according to the Framingham risk score (FRS) wasData regarding CVD burden and trends among Hispanics living in the United States is also alarming and represents the most likely cause of death among this population (5), about 31% of all deaths (6). The prevalence of heart disease is 8.1% in Hispanics and 12.1% in Caucasians (7) and the prevalence of obesity (8), diabetes mellitus, hypertension, and dyslipidemia, is generally higher among Hispanics than Caucasians (7, 9).Estimation of CVD risk using prediction models is considered of high importance to public health since it can aid clinical decision-making, guide therapy, and make interventions more cost effective. It may also help direct public policy when measuring risk trends at the population level (10). In the last few decades, several cardiovascular risk prediction models have been created and introduced worldwide.The Framingham risk score (FRS) was the first of such tools and is arguably the most commonly used model for calculating 10-year risk for CVD events in the world. The FRS has been validated and recalibrated in several different populations, including Australia, China, Japan, New Zealand, Spain, and the United States (11)(12)(13)(14). These studies have shown that the FRS may overestimate CVD risk in some populations and under estimate it in others. Some other prediction models include the Prospective Cardiovascular Munster Heart Study (PROCAM) (15), the Reynolds score (16), and the Systematic Coronary Risk Evaluation system (SCORE) (17).The aim of this study was to assess the use and validity of CVD risk prediction models in Latin America and the Caribbean and among Hispanic populations in the United Sta...

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Prediction of Cardiovascular Death in Racial/Ethnic Minorities Using Framingham Risk Factors

Cited by 54 publications

References 21 publications

Cardiorenal Metabolic Syndrome and Cardiometabolic Risks in Minority Populations

Cardiorenal Metabolic Syndrome and Cardiometabolic Risks in Minority Populations

Most Important Articles on Cardiovascular Disease Among Racial and Ethnic Minorities

Validity of cardiovascular risk prediction models in Latin America and among Hispanics in the United States of America: a systematic review

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