Application of a Lifestyle-Based Score to Predict Cardiovascular Risk in African Americans: The Jackson Heart Study

• Type of Material: Article
• Authors: Mercedes Sotos-Prieto, Universidad Autónoma de Madrid; Songzhu Zhao, Ohio State University; David Kline, Ohio State University; Guy Brock, Ohio State University; Holly Gooding, Emory University; Josiemer Mattei, Harvard T.H. Chana School of Public Health; Fernando Rodriguez-Artalejo, Universidad Autónoma de Madrid; Yuan-I Min, University of Mississippi; Eric B Rimm, Harvard T.H. Chana School of Public Health; Katherine L Tucker, University of Massachusetts Lowell; Joshua J Joseph, Ohio State University
• Language: English
• Date: 2021-06-01
• Publisher: MDPI
• Publication Version: Final Published Version
• Copyright Statement: © 2021 by the authors.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3390/jcm10112252
• Title of Journal or Parent Work: JOURNAL OF CLINICAL MEDICINE
• Volume: 10
• Issue: 11
• Grant/Funding Information: This research was funded by the National Heart, Lung, and Blood Institute, and the National Institute on Minority Health and Health Disparities, contract numbers HHSN268201300046C, HHSN268201300047C, HHSN268201300048C, HHSN268201300049C, HHSN268201300050C. M.S.-P. holds a Ramón y Cajal contract (RYC-2018-025069-I) from the Ministry of Science, Innovation and Universities and FEDER/FSE and a FIS grant PI20/00896 (Instituto de Salud Carlos III, State Secretary of R+D+I and FEDER/FSE). Preparation of this manuscript was supported by The Robert Wood Johnson Foundation (Harold Amos Medical Faculty Development Program ID# 76236, J.J.J.) and the National Institute of Diabetes and Digestive and Kidney Diseases (K23DK117041, J.J.J.) of the National Institutes of Health.
• Keywords: General & Internal Medicine; ADULTS; risk assessment; Life Sciences & Biomedicine; Science & Technology; EVENTS; HEALTH; DISEASE; African Americans; prevention; lifestyle; VALIDATION; WOMEN; Blacks; Medicine, General & Internal; ASSOCIATION
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Medicine and Surgery

Abstract

Cardiovascular disease (CVD) primordial prevention tools applicable to diverse popula-tions are scarce. Our aim was to assess the performance of a lifestyle-based tool to estimate CVD risk in an African American population. The Jackson Heart Study is a prospective cohort including 5306 African American participants in Jackson, Mississippi (2000–2004), with a mean follow up of 12 years. The Healthy Heart Score is a lifestyle-based CVD risk prediction model based on nine components: body mass index (BMI), physical activity, smoking, and a 5-component diet score. Gender-specific beta coefficients from its derivation cohorts were used to assess the performance of the Healthy Heart Score. Model discrimination was assessed using Harrell’s C-Index for survival data and time dependent Area Under the Curve. Model calibration was evaluated through calibration plots. A total of 189 CVD events occurred. The Healthy Heart Score showed high-moderate discrimination for CVD events (C-statistic 0.75 [95% CI, 0.71–0.78]) but with little improvement over the age-only model. Both the age-only and Healthy Heart Score models had better performance in participants without diabetes at baseline and showed good calibration. In African Americans, the Healthy Heart Score does not improve prediction of mid-life CVD events beyond what is obtained by age alone.