This study aimed to compare the performance of short-term (10-year) and long-term (30-year) atherosclerotic cardiovascular disease (ASCVD) risk prediction tools in young adults and evaluate the incidence of ASCVD associated with predicted short-term and long-term risk. The study included 414,260 young adults aged 18 to 39 years from a US integrated health care system and followed them through 2019. The researchers calculated both 10-year and 30-year ASCVD predicted risk and assessed the incidence of ASCVD.
During the follow-up period, 813 young adults had an incident ASCVD event, and the median follow-up time was 4 years (maximum 11 years). The study found that compared with 10-year predicted risk, 30-year predicted risk improved reclassification (net reclassification index: 16%) despite having similar discrimination (Harrell’s C: 0.749 vs 0.726). In other words, the 30-year predicted risk was better at identifying young adults at high risk of developing ASCVD than the 10-year predicted risk.
The study also found that 1.0% and 2.2% of young adults were categorized as having elevated 10-year (≥7.5%) and elevated 30-year (≥20%) predicted risk, respectively. Additionally, 1.6% of young adults were categorized as having low 10-year (<7.5%) but elevated 30-year predicted risk. The ASCVD incidence rate per 1,000 person-years was 2.60 (95% CI: 1.92-3.52) for those with elevated 10-year predicted risk, 1.87 (95% CI: 1.42-2.46) for those with low 10-year but elevated 30-year predicted risk, and 0.32 (95% CI: 0.30-0.35) for those with low 10-year and 30-year predicted risk.
The study concludes that long-term ASCVD risk prediction tools can further discriminate a subgroup of young adults with elevated observed risk despite low estimated short-term risk. This finding suggests that using 30-year predicted risk may be a more accurate way to identify young adults at high risk of developing ASCVD in the long term, even if their short-term risk is low.
Overall, this study highlights the importance of early risk assessment and long-term follow-up for young adults to prevent and manage ASCVD. Identifying high-risk individuals early can help healthcare professionals implement appropriate interventions, including lifestyle changes and medication, to prevent or delay the onset of ASCVD. This study also emphasizes the need for further research to develop more accurate ASCVD risk prediction tools that can identify individuals at high risk of developing the disease in the long term.
https://www.jacc.org/doi/10.1016/j.jacc.2022.11.051
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