The American Heart Association (AHA) has made a significant change to a widely used cardiac-risk algorithm by removing race as a factor in assessing the risk of a heart attack or stroke. The decision to eliminate race from the equation is part of a broader trend toward eliminating racial bias in clinical algorithms and addressing health equity concerns. The AHA’s move acknowledges that race, unlike age or sex, is not a biological risk factor but may serve as a proxy for various social, genetic, or environmental factors that contribute to cardiovascular disease risk.
The revised algorithm aims to avoid using race to inform medical decision-making, emphasizing that race is a social construct rather than a biological predictor. Dr. Sadiya Khan, a preventive cardiologist at Northwestern University Feinberg School of Medicine and the chair of the statement writing committee for the AHA, emphasized that including race in clinical equations can cause significant harm by implying it is a biological predictor. The updated algorithm, named PREVENT, is still in development, and an online calculator is expected to be available soon.
While Black Americans face a higher risk of cardiovascular disease and shorter life expectancy compared to white Americans, using race in algorithms may oversimplify the complex factors contributing to health disparities. The AHA’s decision aligns with the growing awareness of racial bias within the U.S. healthcare system and aims to promote more equitable and accurate risk assessments.
The new algorithm introduces several improvements to the heart-risk assessment. Unlike the previous version, the updated assessment can be used for individuals as young as 30, estimating both 10-year and 30-year total cardiovascular risk. Additionally, it now considers an individual’s risk of developing heart failure, not just heart attack and stroke, acknowledging the increasing prevalence of heart failure due to aging and obesity. The algorithm also incorporates kidney function, recognizing the strong connection between cardiovascular disease, kidney disease, and metabolic disease.
The changes reflect a broader understanding of the interplay between cardiovascular health, kidney function, and metabolic conditions, leading to the identification of a new disorder called cardiovascular-kidney-metabolic syndrome (C.K.M.). The AHA’s updated equation addresses the premature mortality associated with C.K.M., particularly in the presence of adverse social determinants of health.
Furthermore, the new algorithm allows for the inclusion of blood sugar control measurements for individuals with Type 2 diabetes and incorporates the Social Deprivation Index, considering factors such as poverty, unemployment, and education. These enhancements aim to provide a more comprehensive and personalized assessment of cardiovascular risk.
The decision to remove race from the equation is a positive step in addressing health disparities and promoting more equitable healthcare practices. As the AHA continues to refine the algorithm and promote its use, the focus remains on accurate risk assessments that consider a wide range of factors beyond race, ultimately improving the quality of healthcare for all individuals.