Race cannot be used to predict heart disease, scientists say | ET REALITY


Doctors have long relied on a few key patient characteristics to assess the risk of heart attack or stroke, using a calculation that considers blood pressure, cholesterol, smoking and diabetes, as well as demographics. : age, sex and race.

Now, the American Heart Association is removing race from the equation.

the review of the widely used cardiac risk The algorithm is a recognition that, unlike sex or age, racial identification itself is not a biological risk factor.

The scientists who modified the algorithm decided early on that race itself did not belong in the clinical tools used to guide medical decision-making, even though race could serve as an indicator of certain social circumstances, genetic predispositions, or environmental exposures. that increase the risk of cardiovascular disease. disease.

The review comes amid growing concerns about health equity and racial bias within the U.S. health care system, and is part of a broader trend toward removing race from a variety of clinical algorithms.

“We should not use race to inform whether someone receives treatment or not,” said Dr. Sadiya Khan, a preventive cardiologist at Northwestern University Feinberg School of Medicine who chaired the American Heart Association’s statement-writing committee. or AHA

He statement was published Friday in the association’s magazine, Circulation. An online calculator that uses the new algorithm, called PREVENT, is still being developed.

“Race is a social construct,” Dr. Khan said, adding that including race in clinical equations “can cause significant harm by implying that it is a biological predictor.”

That doesn’t mean black Americans aren’t at higher risk of dying from cardiovascular disease than white Americans, he said. They are, and the life expectancy of African Americans is shorter, too, she added.

But race has been used in algorithms as a proxy for a variety of factors that work against African Americans, Dr. Khan said. It’s not clear to scientists what all those risks are. If they were better understood, “we could address them and work to change them,” he said.

Cardiac risk assessment has also been improved in other important ways. It can be used by people up to 30 years old, unlike the previous algorithm, which was only valid for people 40 years old or older, and estimates total cardiovascular risk at 10 and 30 years.

The assessment has been redesigned, for the first time, to estimate an individual’s risk of developing heart failure, not just heart attack and stroke. This is important because heart failure has increased in recent years with the aging population and the high prevalence of obesity. The condition can cause a serious deterioration in quality of life.

Also for the first time, the new calculator takes kidney function into account when predicting risk, as kidney disease puts people at higher risk for heart disease, heart attacks, heart failure and stroke.

In recent years, there has been increasing recognition of the strong connection between cardiovascular disease, kidney disease, and metabolic diseases (including type 2 diabetes and obesity). Last month, the association’s scientific advisors defined a new disorder called cardiovascular-kidney-metabolic syndrome, or CKM.

“CKM is associated with significantly premature mortality, primarily from cardiovascular disease,” said Dr. Chiadi Ndumele, a cardiologist at Johns Hopkins Medicine, who also authored the new scientific statement.

“It is disproportionately present when there are adverse social determinants of health,” he said, including “the social context in which we eat, work, learn and play.”

The new equation also has options to include a measure of blood sugar control, called hemoglobin A1C, in people with type 2 diabetes, and to incorporate a factor called the Social Deprivation Index, which includes poverty, unemployment, education and other factors.

The changes are “great news,” said Dr. David S. Jones, a psychiatrist and professor of the history of medicine at Harvard, who wrote an article about the use of race in countless medical decision-making algorithms which was published in the New England Journal of Medicine in 2020.

The article describes how race has been used in a wide range of clinical algorithms used to make medical judgments about conditions as diverse as urinary tract infections, vaginal birth after cesarean section, breast cancer, lung function, and kidney function.

“It has been enormously gratifying to see how medical thinking on this topic has changed over the last three to five years,” Dr. Jones said.

While racial gaps exist in many health measures, scientists must conduct research to understand exactly what is causing the differences, he said, adding: “You can’t just divide the world between blacks and whites, and say that all whites understand this and all black people understand that.”

However, implementing the changes can be difficult, he said.

Two years ago, a scientific working group from the National Kidney Foundation and the American Society of Nephrology called for scrapping a measure of kidney function that adjusted results by race, which often made black patients appear less sick than they thought. that were and caused delays in treatment.

Within 18 months, about 65 percent of all lab facilities had adopted the new approach, said Dr. Neil Powe, chief of medicine at Zuckerberg General Hospital in San Francisco and professor of medicine at the University of California, San Francisco. .

Dr. Powe said he shared a concern raised by the authors of the AHA scientific statement: What exactly is at the root of racial health disparities?

“I have said many times that we need to do more research to understand what breed is trapping and what its substitute is,” Dr Powe said.

Many physicians do not know if or to what extent their patients are experiencing social stressors that affect their health. Research on maternal deaths, for example, has shown that wealth and higher education do not offset the harmful health effects associated with being black in the United States.

Although the wealthiest mothers and their babies are more likely to survive a year after giving birth, a California study found that the same is not true for black women: the wealthiest black mothers and their babies are twice as likely to die, compared to wealthier white women. mothers and their babies.

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