ACC/AHA 2018 guidelines recommend using Non-Hispanic (NH)-White pooled cohort equations (PCE) to estimate 10-year risk of atherosclerotic cardiovascular disease (ASCVD) among Hispanics. If African ancestry is present, the PCE for Blacks is recommended. African ancestry estimates among Hispanic Community Health Study/Study of Latinos (HCHS/SOL) background groups have been reported.
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We applied the PCE based on fractional African ancestry to HCHS/SOL participants and compared risk estimates from NH-White and NH-Black PCE in these groups. HCHS/SOL participants aged 40-75 years were divided into two groups based on median fractional African ancestry of ~10%: groups with >=10% or higher African Ancestry (Puerto Rican, Central Americans, and Dominicans) and those with <10% or lower African ancestry (Mexicans, South Americans, Cubans). Mean predicted ASCVD incidence using both PCE's was assessed. ASCVD risk frequencies are weighted using survey methods. Differences were determined by Rao-Scott Chi-square test. The PCE was applied to 9091 HCHS/SOL participants. (mean age 53.5, 48% F) Applying the NH-White PCE to lower African ancestry groups led to 38% of participants being classified as intermediate/high (>7.5%) ASCVD risk compared to 45% using the NH-Black PCE. Using the NH-White PCE in groups with higher African ancestry led to 36% of participants being classified as intermediate/high risk compared to 46% using the NH-Black PCE. ASCVD risk estimates per Hispanic background groups are shown.
(Figure 1C
). Our study is the first to apply both NH-Black and NH-White PCE to Hispanics and assess differences based on fractional African ancestry. The NH-Black PCE provided consistently greater estimates in both groups with slightly greater differential of estimates relative to NH-White PCE in those with higher African Ancestry. Further studies with outcomes data are needed to determine optimal application of PCE in Hispanics based upon fractional African Ancestry.
Cardiovascular disease risk factors and psychological distress among Hispanics/Latinos: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL)