In a significant shift, cardiologists are moving away from race-based risk calculators for heart disease, opting instead for a more nuanced approach that considers social factors. The American Heart Association’s new PREVENT calculator, quietly released in January, marks a departure from traditional methods by incorporating ZIP codes to assess cardiovascular risk.
For years, race has been a contentious factor in heart disease risk prediction. The widely used atherosclerotic cardiovascular disease (ASCVD) calculator included race, potentially overestimating risk for Black patients. This led to concerns about overprescribing statins and perpetuating harmful stereotypes.
The PREVENT calculator aims to address these issues by replacing race with a community’s social deprivation index, derived from ZIP codes. This index considers factors like poverty and unemployment rates, acknowledging the impact of social determinants on heart health.
Dr. Sadiya Khan, a preventive cardiologist involved in developing PREVENT, emphasized the importance of balancing accuracy and equity. The new tool performed well across diverse populations without relying on race as a predictor.
However, challenges remain. The inclusion of social factors in medical predictions is still controversial, with concerns about potentially disadvantaging patients of lower socioeconomic status. Additionally, the limited improvement in predictive accuracy when adding social factors highlights the complex relationship between social determinants and health outcomes.
As the medical community grapples with these changes, patients like Dr. Joseph Wright, a physician and health equity advocate, are experiencing the real-world implications. Wright’s personal experience underscores the potential for race-based calculators to overestimate risk and the importance of personalized care.
See “How race became ubiquitous in medical decision-making tools” (September 6, 2024)
