Race has no impact on calculating cardiovascular risk, study finds

Removing racial information from cardiovascular risk calculators, which predict the likelihood of developing heart disease, does not affect patients’ risk scores, according to a study led by Weill Cornell Medicine and investigators at NewYork-Presbyterian.

The study, published in JAMA Cardiology on December 6, adds to a growing body of evidence questioning the use of race in medical decision-making. Currently, doctors use cardiovascular risk assessments that include personal health information, gender, and race to assess a person’s likelihood of developing heart disease. The risk score can then guide lifestyle changes and medications to prevent disease.

This study demonstrated that removing race from the pooled risk equations of the atherosclerotic cardiovascular cohort did not change a patient’s risk score. Additionally, adding social determinants of health to the equation had no effect.

“The main takeaway is that we need to rethink the idea of ​​race in predicting cardiovascular risk,” said lead author Dr. Arnab Ghosh, assistant professor of medicine at Weill Cornell Medicine and hospitalist at NewYork-Presbyterian /Weill Cornell Medical Center. “We need to start thinking about race as a social construct that affects people throughout their lives, not a biological construct.”

Indeed, the paradigm is changing. Last month, the American Heart Association developed a new cardiovascular risk calculator that eliminates the race factor.

“As we increasingly recognize race as a social construct, we move closer to understanding the underlying mechanisms of health care disparities. Continued work in this area can hopefully lead to the development and implementation of interventions aimed at improving equity in our health system,” added the senior official. author Dr. Parag Goyal, Etingin Family Clinical Scholar, Associate Professor of Medicine at Weill Cornell Medicine and Attending Physician at NewYork-Presbyterian/Weill Cornell Medical Center.

Does race have a role in risk calculation?

The use of race in clinical decision-making has received increased scrutiny in recent years. For example, many healthcare institutions have removed race from kidney function calculations because studies have shown that it contributes to delayed kidney care for black patients. Similarly, studies have shown that the use of race and ethnicity in assessing lung function leads to underdiagnosis of black patients with lung disease.

Given these developments, Dr. Ghosh and colleagues wanted to test to what extent removing race from cardiovascular risk assessment calculations affected accuracy, if at all. The team analyzed data from the Reasons for Geographic And Racial Differences in Stroke (REGARDS) study, which includes more than 30,000 black and white participants, ages 45 to 79, who are followed over time. Dr. Ghosh’s study included 12,000 of these participants and analyzed the results over a period of up to 10 years.

Dr. Monika M. Safford, John J. Kuiper Professor of Medicine and chief of the Division of General Internal Medicine at Weill Cornell Medicine, is leading REGARDS’ large ancillary study that focuses on heart-related outcomes, complementing the existing emphasis on strokes study. parental study; the REGARDS-MI auxiliary study group gave rise to this study.

“The orthodoxy that racial differences in cardiovascular outcomes requires us to view these groups differently,” said Dr. Ghosh, who is also a member of the Center of Health Equity at Cornell University. “But we wanted to assess whether this hypothesis holds up empirically.”

Race as a social and not biological construction

Despite well-documented racial and ethnic disparities in heart disease outcomes, Dr. Ghosh and his colleagues were surprised to find that race and social determinants of health had no effect on risk. They concluded that measuring risk factors such as blood pressure, diabetes and cholesterol, used in the calculators, can accurately predict risk without using race.

“The social impact of race on blood pressure and other health factors are still present, which may explain the predictive power of calculators even without explicitly using race,” he said.

Additionally, the older age of REGARDS study participants may explain why social determinants did not impact risk calculations. Dr. Ghosh explained that the effects of social determinants of health, such as living in a segregated neighborhood or experiencing racism, accumulate over the lifespan and can lead to health problems like high blood pressure or cholesterol.

Thus, adding early life social determinants of health as separate factors makes no difference since their effects are integrated with patient-measured health-related cardiovascular risk factors.

Next, Dr. Ghosh and colleagues will evaluate the use of race and social determinants in calculating risk across patients’ lives. They plan to apply machine learning algorithms to develop risk prediction models incorporating many traditional and non-traditional cardiovascular risk factors, such as the effects of living in communities affected by policies favoring racial segregation.

“It is critical that clinicians and scientists consider how to appropriately address the health effects of race as a social construct, which has contributed to cardiovascular health disparities,” said Dr. Ghosh.