Tool to Assess Cardiovascular Risk May be Inaccurate in Older Adults

November 5, 2019 – A DCRI-led study is the first to test the performance of the Pooled Cohort Risk Equations, a commonly used tool for assessing cardiovascular risk, in older adults.

Recent findings from the DCRI suggest that a key tool used to assess cardiovascular risk and guide therapy strategies for prevention is inadequate when used to assess adults who are 75 or older.

The study, which was led by DCRI fellow Michael Nanna, MD, and recently published in the Journal of General Internal Medicine, used data from four large studies to examine performance of the tool, Pooled Cohort Risk Equations (PCE). The study included 9,864 individuals between ages 40 and 74 and 2,663 individuals who were 75 or older.

Current guidance from the American College of Cardiology and the American Heart Association relies on the PCE as the main tool to estimate cardiovascular risk in primary prevention populations, or people without cardiovascular disease. However, the PCE were developed based on a younger population, and no studies have tested their efficacy in adults who are 75 or older.

The study’s results showed that the PEC performed worse in accurately predicting risk in the group of older adults. Specifically, it overestimated risk for those individuals at highest-risk thresholds. Researchers say that overall, the model’s lower performance in this group could be driven by the higher risk of non-cardiovascular mortality in these older adults.

The study team also examined whether the tool’s performance varied by gender because research shows clearly documented differences between the sexes as it pertains to cardiovascular risk. When applied to women and men 75 years or older, the PEC performed poorly in both genders. When the population was further stratified to only include adults 80 years or older, who were not included in the original derivation or validation of the PCE, the tool performed similarly poorly.

“These findings highlight the need to develop geriatric-specific risk stratification tools,” Nanna said. “Only when we as providers have a clearer picture of future cardiovascular risk in this population will we be able to engage in patient-centered conversations with these individuals and make truly informed decisions about treatment options.”

Other DCRI contributors to this study include Eric Peterson, MD, MPH; Ann Marie Navar, MD, PhD; and Daniel Wojdyla, MS.