--- title: "CVD risk prediction in Asian and Hispanic subgroups in EHRs. | Sutter Health" description: "Pooled Cohort Equations generally overestimated ASCVD risk, with marked heterogeneity by disaggregated Asian and Hispanic subgroups." url: "https://www.sutterhealth.org/research/publications/cvd-risk-prediction-in-asian-and-hispanic-subgroups-in-ehrs-1055312765" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. CVD risk prediction in Asian and Hispanic subgroups in EHRs. # Atherosclerotic cardiovascular disease risk prediction in disaggregated Asian and Hispanic subgroups using electronic health records. Rodriguez F, Chung S, Blum MR, Coulet A, Basu S, & Palaniappan LP. _J Am Heart Assoc. 8(14):e011874. doi: 10.1161/JAHA.118.011874. Epub 2019 Jul 11._ 2019-07-16 ## Abstract ****Background**** Risk assessment is the cornerstone for atherosclerotic cardiovascular disease ( ASCVD ) treatment decisions. The Pooled Cohort Equations ( PCE ) have not been validated in disaggregated Asian or Hispanic populations, who have heterogeneous cardiovascular risk and outcomes. ****Methods and Results**** We used electronic health record data from adults aged 40 to 79 years from a community-based, outpatient healthcare system in northern California between January 1, 2006 and December 31, 2015, without ASCVD and not on statins. We examined the calibration and discrimination of the PCE and recalibrated the equations for disaggregated race/ethnic subgroups. The cohort included 231 622 adults with a mean age of 53.1 (SD 9.7) years and 54.3% women. There were 56 130 Asian (Chinese, Asian Indian, Filipino, Japanese, Vietnamese, and other Asian) and 19 760 Hispanic (Mexican, Puerto Rican, and other Hispanic) patients. There were 2703 events (332 and 189 in Asian and Hispanic patients, respectively) during an average of 3.9 (SD 1.5) years of follow-up. The PCE overestimated risk for NHWs, African Americans, Asians, and Hispanics by 20% to 60%. The extent of overestimation of ASCVD risk varied by disaggregated racial/ethnic subgroups, with a predicted-to-observed ratio of ASCVD events ranging from 1.1 for Puerto Rican patients to 1.9 for Chinese patients. The PCE had adequate discrimination, although it varied significantly by race/ethnic subgroups (C-indices 0.66-0.83). Recalibration of the PCE did not significantly improve its performance. ****Conclusions**** Using electronic health record data from a large, real-world population, we found that the PCE generally overestimated ASCVD risk, with marked heterogeneity by disaggregated Asian and Hispanic subgroups. [PubMed abstract](https://www.ncbi.nlm.nih.gov/pubmed/31291803) ## Research topics - [Cardiovascular Diseases](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Cardiovascular+Diseases%5C%22%22) - [Health Disparities](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Health+Disparities%5C%22%22) - [Medical Informatics](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Medical+Informatics%5C%22%22) - [Prevention and Health Maintenance](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Prevention+and+Health+Maintenance%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Statin utilization and low-density lipoprotein cholesterol in statin-treated patients with atherosclerotic cardiovascular disease: trends from a community-based health care delivery system, 2002-2016.](https://www.sutterhealth.org/research/publications/statin-use-and-ldl-in-statin-treated-patients-with-ascvd-1055312752) Romanelli RJ, Ito MK, Karalis DG, Huang HC, Iorga SR, Kam IW, Thompson S, Azar KMJ. J Clin Lipidol. pii: S1933-2874(20)30068-4. doi: 10.1016/j.jacl.2020.03.006. \[Epub ahead of print\] 2020 Apr 10 - Publication ### [Heterogeneity of treatment and outcomes among Asians with coronary artery disease in the United States.](https://www.sutterhealth.org/research/publications/treatment-and-outcomes-among-asians-with-cad-in-us-1055312760) Manjunath L, Chung S, Li J, Shah H, Palaniappan L, Yong CM. J Am Heart Assoc. e014362. doi: 10.1161/JAHA.119.014362. \[Epub ahead of print\] 2020 May 11 - Publication ### [Preventive visit among older adults with Medicare's introduction of Annual Wellness Visit: closing gaps in underutilization.](https://www.sutterhealth.org/research/publications/annual-wellness-visits-preventive-visits-in-seniors-1055312376) Chung S, Romanelli RJ, Stults C, Luft H. Prev Med. https://doi.org/10.1016/j.ypmed.2018.08.018 2018 Aug 23 - Publication ### [Profiles of sociodemographic, behavioral, clinical and psychosocial characteristics among primary care patients with comorbid obesity and depression.](https://www.sutterhealth.org/research/publications/characteristics-primary-care-pts-with-obesity-depression-1055312347) Ma J, Xiao L, Lv N, Rosas LG, Lewis MA, Goldhaber-Fiebert JD, Venditti EM, Snowden MB, Lesser L, Ward E. Prev Med Rep. 8:42-50. doi: 10.1016/j.pmedr.2017.07.010. eCollection 2017 Dec. 2017 Aug 05 - Publication ### [A Latino Patient-Centered, Evidence-Based Approach to Diabetes Prevention.](https://www.sutterhealth.org/research/publications/latino-pt-centered-evidence-based-approach-to-dm-prevention-1055312326) Rosas LG, Lv N, Lewis MA, Venditti EM, Zavella P, Luna V, Ma J. J Am Board Fam Med. 31(3):364-374. doi: 10.3122/jabfm.2018.03.170280. 2018 May 01 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/cvd-risk-prediction-in-asian-and-hispanic-subgroups-in-ehrs-1055312765#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"CVD risk prediction in Asian and Hispanic subgroups in EHRs."}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/cvd-risk-prediction-in-asian-and-hispanic-subgroups-in-ehrs-1055312765#medicalscholarlyarticle","name":"Atherosclerotic cardiovascular disease risk prediction in disaggregated Asian and Hispanic subgroups using electronic health records.","headline":"CVD risk prediction in Asian and Hispanic subgroups in EHRs.","abstract":"Background Risk assessment is the cornerstone for atherosclerotic cardiovascular disease ( ASCVD ) treatment decisions. The Pooled Cohort Equations ( PCE ) have not been validated in disaggregated Asian or Hispanic populations, who have heterogeneous cardiovascular risk and outcomes. Methods and Results We used electronic health record data from adults aged 40 to 79 years from a community-based, outpatient healthcare system in northern California between January 1, 2006 and December 31, 2015, without ASCVD and not on statins. We examined the calibration and discrimination of the PCE and recalibrated the equations for disaggregated race/ethnic subgroups. The cohort included 231 622 adults with a mean age of 53.1 (SD 9.7) years and 54.3% women. There were 56 130 Asian (Chinese, Asian Indian, Filipino, Japanese, Vietnamese, and other Asian) and 19 760 Hispanic (Mexican, Puerto Rican, and other Hispanic) patients. There were 2703 events (332 and 189 in Asian and Hispanic patients, respectively) during an average of 3.9 (SD 1.5) years of follow-up. The PCE overestimated risk for NHWs, African Americans, Asians, and Hispanics by 20% to 60%. The extent of overestimation of ASCVD risk varied by disaggregated racial/ethnic subgroups, with a predicted-to-observed ratio of ASCVD events ranging from 1.1 for Puerto Rican patients to 1.9 for Chinese patients. The PCE had adequate discrimination, although it varied significantly by race/ethnic subgroups (C-indices 0.66-0.83). Recalibration of the PCE did not significantly improve its performance. Conclusions Using electronic health record data from a large, real-world population, we found that the PCE generally overestimated ASCVD risk, with marked heterogeneity by disaggregated Asian and Hispanic subgroups.","description":"Pooled Cohort Equations generally overestimated ASCVD risk, with marked heterogeneity by disaggregated Asian and Hispanic subgroups.","keywords":["Cardiovascular Diseases","Health Disparities","Medical Informatics","Prevention and Health Maintenance"],"datePublished":"2019-07-16","url":"https://www.sutterhealth.org/research/publications/cvd-risk-prediction-in-asian-and-hispanic-subgroups-in-ehrs-1055312765","inLanguage":"en-US","identifier":[{"@type":"PropertyValue","propertyID":"PMID","value":"31291803"},{"@type":"PropertyValue","propertyID":"DOI","value":"10.1161/JAHA.118.011874"}],"sameAs":["https://pubmed.ncbi.nlm.nih.gov/31291803/","https://doi.org/10.1161/JAHA.118.011874"],"isPartOf":{"@type":"Periodical","name":"J Am Heart Assoc"},"author":[{"@type":"Person","name":"Rodriguez F"},{"@type":"Person","name":"Chung S"},{"@type":"Person","name":"Blum MR"},{"@type":"Person","name":"Coulet A"},{"@type":"Person","name":"Basu S"},{"@type":"Person","name":"Palaniappan LP"}],"sourceOrganization":{"@type":"MedicalOrganization","name":"Palo Alto Medical Foundation Research Institute"},"about":[{"@type":"DefinedTerm","name":"Cardiovascular Diseases","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Cardiovascular+Diseases%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Health Disparities","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Health+Disparities%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Medical Informatics","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Medical+Informatics%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Prevention and Health Maintenance","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Prevention+and+Health+Maintenance%22%5D%7D%5D&verticalKey=research_publication"}],"mainEntityOfPage":{"@type":"WebPage","@id":"https://www.sutterhealth.org/research/publications/cvd-risk-prediction-in-asian-and-hispanic-subgroups-in-ehrs-1055312765","breadcrumb":{"@id":"https://www.sutterhealth.org/research/publications/cvd-risk-prediction-in-asian-and-hispanic-subgroups-in-ehrs-1055312765#breadcrumblist"}}} ```