Higher PREVENT-estimated CVD risk was associated with increased all-cause mortality (HR 1.55 per 5% increase; 95% CI 1.47-1.64), with the association attenuated by higher SDOH burden.
Cohort (n=18,694)
Sí
Does adding social determinants of health (SDOH) to the AHA PREVENT equations improve discrimination for all-cause and cardio-cerebrovascular mortality in US adults?
Adding social determinants of health to the AHA PREVENT equations modestly improves mortality discrimination, supporting the incorporation of social risk in cardiovascular risk stratification.
Estimación del efecto: HR 1.55 (95% CI 1.47-1.64)
ABSTRACT Background The American Heart Association (AHA) PREVENT equations provide contemporary estimates of 10‐year cardiovascular disease (CVD) risk. Although PREVENT was developed to estimate incident CVD risk, its relation to subsequent mortality in nationally representative US adults has not been well characterised. It also remains unclear whether social determinants of health (SDOH) modify these associations and improve discrimination beyond PREVENT. Methods Adults aged 40–75 years in NHANES 2003–2018 were linked to the National Death Index through December 31, 2019. SDOH burden was derived by summing 8 unfavourable SDOH components and categorised as 0, 1–2, 3–4 or ≥ 5. Survey‐weighted Cox models were used to evaluate associations with all‐cause and cardio‐cerebrovascular disease (CCD) mortality, defined as a composite of cardiovascular and cerebrovascular mortality. Effect modification was assessed using multiplicative interaction terms. Incremental discrimination after adding SDOH to PREVENT was evaluated using time‐dependent receiver operating characteristic (ROC) curves. Results Among 18 694 adults (mean age, 54.3 years; 52.6% women), 1646 all‐cause deaths and 392 CCD deaths occurred over a median follow‐up of 8.2 years (IQR, 4.3–12.3). In multivariable models, each 5–percentage‐point higher PREVENT‐estimated risk was associated with higher all‐cause mortality (HR = 1.55; 95% CI, 1.47–1.64) and CCD mortality (HR = 1.62; 95% CI, 1.52–1.74). Heterogeneity by SDOH burden was demonstrated ( p for interaction < 0.001 for both outcomes), with stronger associations in the 0‐unfavourable group (all‐cause: HR = 2.01; 95% CI, 1.79–2.25; CCD: HR = 2.35; 95% CI, 1.91–2.88) and attenuated associations in the ≥ 5‐unfavourable group (all‐cause: HR = 1.38; 95% CI, 1.26–1.50; CCD: HR = 1.46; 95% CI, 1.31–1.62). At 10 years, discrimination improved after adding SDOH to PREVENT (all‐cause AUC: 0.747 to 0.778; p < 0.001; CCD AUC: 0.790 to 0.812; p = 0.042). Conclusions SDOH burden was associated with graded mortality and modified the strength of the association between PREVENT‐estimated 10‐year CVD risk and mortality. Adding SDOH modestly improved mortality discrimination beyond PREVENT alone, supporting incorporation of social risk in risk stratification.
寇明清 et al. (Sun,) conducted a cohort in Cardiovascular disease risk (n=18,694). AHA PREVENT equations and Social Determinants of Health (SDOH) burden was evaluated on all-cause mortality per 5-percentage-point higher PREVENT-estimated risk (HR 1.55, 95% CI 1.47-1.64). Higher PREVENT-estimated CVD risk was associated with increased all-cause mortality (HR 1.55 per 5% increase; 95% CI 1.47-1.64), with the association attenuated by higher SDOH burden.