Roni Caryn Rabin, New York Times, November 14, 2023
Doctors have long relied on a few key patient characteristics to assess risk of a heart attack or stroke, using a calculus that considers blood pressure, cholesterol, smoking and diabetes status, as well as demographics: age, sex and race.
Now, the American Heart Association is taking race out of the equation.
The overhaul of the widely used cardiac-risk algorithm is an acknowledgment that, unlike sex or age, race identification in and of itself is not a biological risk factor.
The scientists who modified the algorithm decided from the start that race itself did not belong in clinical tools used to guide medical decision making, even though race might serve as a proxy for certain social circumstances, genetic predispositions or environmental exposures that raise the risk of cardiovascular disease.
The revision comes amid rising concern about health equity and racial bias within the U.S. health care system, and is part of a broader trend toward removing race from a variety of clinical algorithms.
“We should not be using race to inform whether someone gets a treatment or doesn’t get a treatment,” said Dr. Sadiya Khan, a preventive cardiologist at Northwestern University Feinberg School of Medicine, who chaired the statement writing committee for the American Heart Association, or A.H.A.
The statement was published on Friday in the association’s journal, Circulation. An online calculator using the new algorithm, called PREVENT, is still in development.
“Race is a social construct,” Dr. Khan said, adding that including race in clinical equations “can cause significant harm by implying that it is a biological predictor.”
That doesn’t mean that Black Americans are not at higher risk of dying of cardiovascular disease than white Americans, she said. They are, and life expectancy of Black Americans is shorter as well, she added.
But race has been used in algorithms as a stand-in for a range of factors that are working against Black Americans, Dr. Khan said. It’s not clear to scientists what all of those risks are. If they were better understood, “we could address them and work to modify them,” she said.
The heart-risk assessment has also been improved in several other significant ways. It can be used by people as young as 30, unlike the earlier algorithm, which was only valid for those 40 and over, and estimates the 10-year and 30-year total cardiovascular risk.
The assessment has been redesigned, for the first time, to estimate an individual’s risk of developing heart failure, not just heart attack and stroke. That is important because heart failure has been on the rise in recent years with the aging of the population and the high prevalence of obesity. The condition can lead to a severe deterioration in quality of life.
Also for the first time, the new calculator takes kidney function into account when predicting risk, as kidney disease puts people at higher risk of heart disease, heart attacks, heart failure and stroke.