Cardiovascular risk calculator can lead to overtreatment of black patients, the study shows

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

The Boston University School of Medicine authors who performed the analysis describe these differences as “biologically unlikely” in their report. These results illustrate another way in which black patients tend to be treated differently than white patients. Unlike previous analyzes that show that black patients are likely to receive inadequate care, this new study provides an example that this population is at risk for too much medical treatment.

“While the direction of this potential bias may seem somewhat reassuring (compared to the opposite scenario with black people not receiving statins relative to their white counterparts), the risks associated with overtreatment – ie, financial, psychological, side effects and quality of life – are not trivial, “the authors wrote.

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

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Researchers created about 50,000 combinations of different risk factors through the calculator and examined those that generated scores high enough to signal to doctors that patients needed preventative care, according to a press release from Boston University School of Medicine.

Factors such as cholesterol levels, smoking history and race are calculated in a calculator created by the two medical groups. If the score is above 7.5% for having 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, “black-and-white differences in risk predicted by these equations can result in different treatment decisions,” according to the Boston University School of Medicine. “Often, blacks will be prescribed a statin because they are considered to have higher risk. The difference in predicted risk (black vs. white with identical risk factors) can be as large as 22.8 percent for men and 26.8 percent for women. “

Race itself should not be a stand-in for actual risk factors for heart disease, which could include some degree of the social determinants of health such as housing security, food insecurity and economic challenges, the researchers wrote.

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

These results come as there is an increased push to capture race data in healthcare settings – and warnings that the use of this data in predictive algorithms may not be appropriate. Race does not necessarily equal socioeconomic status, genetics or environment, and can be driving either overtreatment or undertreatment.

In an accompanying editorial, the Lancet Digital Health editors undertook to collect demographic data, such as including race and ethnicity for all submitted research articles, and require authors to explain why this information is not available in cases where it is not included.

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