Cardiovascular risk calculator could lead to over-treatment of black patients, study says

According to a study published in the Lancet this month, a risk calculator from the American College of Cardiology and the American Heart Association gives black patients much worse cardiovascular health predictions than white patients, even if their risk profiles are identical, regardless of race.

The authors of the Boston University School of Medicine who conducted the analysis describe these differences as “biologically implausible” in their research. report… These results illustrate a different approach to treating black patients compared to white patients. Unlike previous analyzes showing that black patients are more likely to receive insufficient care, this new study provides an example of this population at risk of too much care.

“While the direction of this potential bias may seem somewhat reassuring (compared to the opposite scenario, where blacks are not on statins compared to their white counterparts), the risks associated with overtreatment, i.e., financial, psychological, side effects, and quality life is non-trivial, ”wrote the authors.

The American College of Cardiology and the American Heart Association did not respond to requests for comment.

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Researchers have created about 50,000 combinations of different risk factors using calculator and examined those that scored high enough to tell doctors that patients need preventive care, according to Boston University School of Medicine. news release

Factors such as cholesterol, smoking and race are factored into a calculator created by two medical groups. If the score is above 7.5% for an event such as a heart attack or stroke within the next 10 years, the American College of Cardiology and the American Heart Association recommend treatments such as statins.

In about 20% of risk factor combinations, “the black and white differences in risk predicted by these equations may lead to a different solution,” according to Boston University School of Medicine. “Most blacks are prescribed statins because they are at higher risk. The difference in predicted risk (blacks and whites with identical risk factors) could be as high as 22.8 percent for men and 26.8 percent for women. ”

The researchers write that race alone should not replace actual risk factors for heart disease, which may include some of the social determinants of health, such as housing security, food insecurity, and economic problems.

“Race must be replaced in any risk prediction equation by various potentially causal factors that race represents and can be targeted by intervention,” the authors write.

These results come in response to the growing push for the collection of race data in health care settings and warnings that the use of this data in prediction algorithms may be impractical. Race does not necessarily equate to socioeconomic status, genetics, or environment, and can be the cause of over or under treatment.

In the accompanying editorialThe editors of Lancet Digital Health have pledged to collect demographic data, including race and ethnicity, for all submitted research papers, and require authors to explain why this information is not available when it is not included.

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