Abstract: FR-OR016

Accuracy of ACC/AHA ASCVD Risk Estimator by eGFR in a Large, Multiethnic Non-Diabetic Population

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 303 CKD: Epidemiology, Outcomes - Cardiovascular

Authors

  • Go, Alan S., Kaiser Permanente Northern California, Oakland, California, United States
  • Tabada, Grace Hsu, Kaiser Permanente Northern California, Oakland, California, United States
  • Jonelis, Tracy Y., Kaiser Permanente Northern California, Oakland, California, United States
  • Sung, Sue hee, Kaiser Permanente Northern California, Oakland, California, United States
  • Rana, Jamal S, Kaiser Permanente Northern California, Oakland, California, United States
Background

Earlier atherosclerotic cardiovascular disease (ASCVD) prediction equations have limited utility in adults with kidney disease. The ACC/AHA ASCVD Risk Estimator has been recommended to assist with primary prevention planning, but its accuracy varies in contemporary populations and little is known about its performance by level of kidney function. We evaluated its accuracy and discrimination in a large community-based population across the range of eGFR.

Methods

Within Kaiser Permanente Northern California, we identified members age 40-75 years in 2008 who had LDL-C 70-189 mg/dL, no prior ASCVD or lipid-lowering therapy, no diabetes, available eGFR, and full 5-year follow-up. Non-fatal and fatal ASCVD events through 2013 were ascertained from electronic health records using validated algorithms. We compared observed vs. ACC/AHA Risk Estimator-based 5-year risk of ASCVD events by baseline eGFR (90-150, 60-89, 45-59 and <45 ml/min/1.73m2) with associated c statistics.

Results

In 283,354 non-diabetic adults, mean age was 55 years, 61% women and 32% minorities. Overall, the distribution of 5-year predicted ASCVD risk was <2.5% (55%), 2.5% to <5.0% (21%) and ≧5.0% (24%), with higher proportions of patients at high predicted ASCVD risk with lower eGFR. Going from eGFR 90-150 to 45-59, there was progressively less overestimation of actual 5-year ASCVD risk using the ACC/AHA ASVD Risk Estimator, with underestimation of risk for eGFR <45 (Figure). Discrimination was only modest across eGFR levels (c=0.59-0.65).

Conclusion

Accuracy of the ACC/AHA ASCVD Risk Estimator varies by eGFR level, and recalibration in contemporary, ethnically diverse populations would increase its utility to assist with primary prevention strategy decision-making.

Utility of ACC/AHA ASCVD Risk Estimator by Category of eGFR