Atherosclerotic Cardiovascular Disease Risk Prediction Models in China, Japan, and Korea

The management of atherosclerotic cardiovascular disease (ASCVD) in the United States is currently based upon large epidemiological studies in primarily non-Hispanic White subjects. Although this strategy provides a uniform approach that is simpler to implement, it may result in inappropriately targeting certain Asian populations for treatment based on inaccurate ASCVD risk estimation. In this state-of-the-art review, we detail the similarities and differences in the prevalence of ASCVD and its risk factors among Chinese, Japanese, and Korean people living in the United States and in their native countries. We highlight the limitations of current risk calculators when applied to East Asian immigrants and summarize risk stratification approaches in China, Japan, and Korea. Our review underscores the need to disaggregate registry, cohort, and clinical trial data by East Asian subgroups, to actively engage these populations in research, and to initiate studies to better define ASCVD risk in East Asian people living in the United States. • Prior studies have shown that the prevalence of ASCVD and its risk factors vary across East Asian countries, but whether these differences extend to East Asians living in the United States and how they affect the validity of ASCVD-risk calculators in East Asians in the United States and in their native countries remain unclear. • ASCVD risk calculators, developed by the ACC/AHA, overestimate risk in Chinese, Koreans, and Japanese people. Risk calculators developed by professional organizations in the countries of origin, however, lack validation in East Asians living in the United States, who are exposed to different environmental and cultural influences. • Future studies should include individuals from East Asian subpopulations and report disaggregated findings to inform the development of an ASCVD-risk calculator specific to East Asian U.S. immigrants that can then be prospectively validated.