New 10-Year Atherosclerosis Cardiovascular Disease Risk Score for Asian and American Indian Women Service Members

Figures

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  Figure 1. Flowchart of VA Asian and AI Women Cohort A total of 15,042 Asian and 5,633 American Indian and Alaska Native (AI) women who received care from the military and/or VA Health Care System between January 1, 2007, and December 31, 2022, were included in the study cohort. Women were included if: 1) they were between the ages of 20 and 80 years; 2) had 2 or more SBP and 1 or more cholesterol visits; and 3) no known prior (before first visit) cardiovascular disease event. AI = American Indian and Alaska Native; DaVINCI = Department of Defense and Veterans Affairs Infrastructure; NA = Alaska Native; N-H = non-Hispanic; SBP = systolic blood pressure; VA = Department of Veterans Affairs.

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  Figure 2. Calibration Plots: Asian and AI Women Service Members and Veterans Calibration plots of 10-year ASCVD risk for Asian service members and veterans (A) and AI women service members and veterans (B) were visualized by plotting predicted probability (x-axis) against observed (y-axis). A 45° line represents perfect model accuracy where the predicted and observed probabilities are the same. The closer the plots are to a 45° line, the better is the accuracy. Brier scores are 0.00002 and 0.00006 for Asian and AI women military service members, respectively. Brier score close to “0” indicates a perfect fit (observed probability = predicted probability). AI = American Indian and Alaska Native; ASCVD = atherosclerosis cardiovascular disease; Asian = Asian American or Hawaiian American.

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  Central Illustration. Development and Validation of Department of Veterans Affairs Asian American or Hawaiian American/American Indian and Alaska Native Women Cardiovascular Disease Risk Score This study developed and internally validated the new VA Asian and AI women CVD risk score using data from both the military and VA health system EHR (1. Databases). The study cohort included 15,042 Asian and 5,663 AI women (2. Cohorts). Risk coefficient estimates for variables in model predicting 10-year atherosclerosis cardiovascular disease are presented in panel 3. The model had good discrimination using C-statistics (4A) and calibration plots (4B). A 45-degree line represents perfect model accuracy where predicted and observed probabilities are the same. The closer the plots (4B1 and 4B2) are to a 45-degree line, the better the accuracy. AI = American Indian and Alaska Native; Asian = Asian American or Hawaiian American; CVD = cardiovascular disease; EHR = electronic health record; HDL = high-density lipoprotein; Ln = natural logarithm, SBP = systolic blood pressure; VA = Department of Veterans Affairs.