Abstract 4144359: Performance of Pooled Cohort Equations and the AHA Predicting Risk of cardiovascular EVENTs Equations Among Multiracial Asian and Pacific Islander People

Introduction: The AHA Predicting Risk of cardiovascular EVENTs (PREVENT) Equations were introduced as a race-neutral alternative to the Pooled Cohort Equations (PCE) for predicting risk of ASCVD and heart failure. Although the equations have performed well among single-race groups, it is unknown if the PREVENT equations will perform better than PCE for multiracial individuals, a growing demographic population in the United States. Research Question: Do the PREVENT Equations perform better than the PCE among multiracial Asian and Pacific Islander (API) populations in predicting incident ASCVD? Methods: Using electronic health data from the Cardiovascular Disease Among Asians and Pacific Islanders Study, we examined individuals with complete data for all inputs necessary for both PCE and PREVENT from a large healthcare system in Hawaii (n = 27,784). We included individuals without ASCVD prior to entry and examined follow up for 5 years total. We examined 12 race and ethnic groups, including four multiracial groups: “Asian + White”, “Pacific Islander + White”, “Pacific Islander + Asian”, “Pacific Islander + Asian + White”. We evaluated the performance of PCE and PREVENT by calculating C-statistics with 95% Confidence Intervals (CI). Results: The performance of the PCE and PREVENT equations among the full sample was 0.6831 and 0.6813, respectively, reflecting similar moderate performance across both equations. PCE and PREVENT performance was similar among multiracial API groups (Table). However, there was heterogeneity in discriminative performance by group. PCE performance was worst among “Asian + White” individuals (0.65; [95% CI: 0.58, 0.72]) and best among “Pacific Islander + Asian” individuals (0.76; [95% CI: 0.69, 0.8288). Similar trends were seen in PREVENT; performance was worst among “Asian + White” individuals (0.65 [95% CI: 0.58, 0.72]) and was best among “Pacific Islander + Asian” individuals (0.71; [95% CI: 0.64, 0.78]). Conclusions: The base PREVENT Equations had comparable performance to PCE among multiracial Asian and Pacific Islander groups. Additional work is needed to better evaluate the performance of CVD risk equations among multiracial individuals and other emerging populations.