The Revised Pooled Cohort Equations (RPCE) were associated with CVD mortality (HR 1.65) and displayed improved calibration over the original PCE, especially in diverse populations.
Does the Revised Pooled Cohort Equations (RPCE) model improve risk estimation for cardiovascular and cerebrovascular mortality compared to the original Pooled Cohort Equations (PCE) in a primary prevention population?
The Revised Pooled Cohort Equations offer improved calibration and reduce risk overestimation compared to the original equations while maintaining strong prognostic value for vascular mortality in a diverse US primary prevention cohort.
Absolute Event Rate: 0% vs 0%
ABSTRACT Background Cardiovascular (CVD) and cerebrovascular diseases (CeVD) are leading causes of mortality. The Pooled Cohort Equations (PCE) are widely used for ASCVD risk prediction, but face calibration concerns, particularly in diverse populations. The Revised Pooled Cohort Equations (RPCE) were developed to address these limitations. While prior research has evaluated these models for ASCVD, less is known about their performance for CVD and CeVD mortality outcomes. Objective This study aimed to comprehensively compare the association of PCE and RPCE with CVD mortality and combined CVD and CeVD mortality, including subgroup analyses by race and gender, within a nationally representative US adult population. Methods We analyzed 16,584 primary prevention participants (aged 40–79 years) from National Health and Nutrition Examination Survey (1999–2018), linked to National Death Index mortality data. We calculated 10‐year ASCVD risk using both PCE and RPCE. Bland–Altman plots assessed score agreement. Cox proportional hazards models evaluated the association of standardized PCE and RPCE scores with CVD and combined CVD and CeVD mortality, adjusting for confounders and stratifying by race and gender. Results Both PCE and RPCE were significantly associated with CVD mortality (adjusted hazard ratio (HR) for PCE: 1.91 95% CI: 1.82–2.01; RPCE: 1.65 95% CI: 1.59–1.72) and combined CVD and CeVD mortality (adjusted HR for PCE: 1.91 95% CI: 1.82–2.00; RPCE: 1.65 95% CI: 1.60–1.72). Bland–Altman analyses revealed PCE consistently overestimated risk compared to RPCE, with differences increasing at higher risk levels. RPCE demonstrated improved calibration, especially in racially diverse populations, where PCE overestimation was more pronounced. Conclusion Both PCE and RPCE are robust prognostic tools for vascular mortality. However, RPCE offers improved calibration, particularly in racially diverse populations, by providing more conservative yet comparably predictive risk estimates. These findings highlight the importance of selecting risk models tailored to target populations to optimize prevention and avoid potential overtreatment.
Lu et al. (Thu,) reported a other. The Revised Pooled Cohort Equations (RPCE) were associated with CVD mortality (HR 1.65) and displayed improved calibration over the original PCE, especially in diverse populations.