TY - JOUR
T1 - Differential impact of aging on cardiovascular risk in women military service members
AU - Chen, Xiaofei
AU - Ramanan, Bala
AU - Tsai, Shirling
AU - Jeon-Slaughter, Haekyung
N1 - Publisher Copyright:
© 2020, American Heart Association Inc.. All rights reserved.
PY - 2020/6/16
Y1 - 2020/6/16
N2 - BACKGROUND: Atherosclerotic cardiovascular disease (ASCVD) is the third leading cause of death in women service members and veterans. This study assessed 10-year ASCVD risk in women service members and veterans using their own electronic health record data extracted from Veterans Affairs (VA) national Corporate Data Warehouse database. METHODS AND RESULTS: We retrospectively followed 69 574 VA women, aged 30 to 79 years, from 2007 to 2017. Of these, 52% were whites (n=36 172), 42% were blacks (n=29 232), and 6% were Hispanics (n=4171). Risk factors and ASCVD events (nonfatal myocardial infarction, nonfatal stroke, and cardiac deaths) were identified using diagnostic and procedural codes from electronic health records. Then, within the same construct of the current American College of Cardiology/American Heart Association 10-year ASCVD risk assessment models for women, coefficients for risks factors were recalculated using the VA national electronic health record data, stratified by race (hereafter, VA women model). Our study found a curvilinear association of aging with increased risk of 10-year ASCVD event in VA women starting at ages as young as 30 years across all race groups. The VA women model performance in predicting ASCVD events at 10 years was mixed-moderate in discrimination (C statistics, 0.61–0.64) but good in accuracy, as demonstrated by calibration plots approximating a 45° line. CONCLUSIONS: The study finding, a curvilinear association of aging with increased ASCVD risk in VA women across all races, demonstrates the need for cardiovascular risk screening of younger VA women, aged <45 years.
AB - BACKGROUND: Atherosclerotic cardiovascular disease (ASCVD) is the third leading cause of death in women service members and veterans. This study assessed 10-year ASCVD risk in women service members and veterans using their own electronic health record data extracted from Veterans Affairs (VA) national Corporate Data Warehouse database. METHODS AND RESULTS: We retrospectively followed 69 574 VA women, aged 30 to 79 years, from 2007 to 2017. Of these, 52% were whites (n=36 172), 42% were blacks (n=29 232), and 6% were Hispanics (n=4171). Risk factors and ASCVD events (nonfatal myocardial infarction, nonfatal stroke, and cardiac deaths) were identified using diagnostic and procedural codes from electronic health records. Then, within the same construct of the current American College of Cardiology/American Heart Association 10-year ASCVD risk assessment models for women, coefficients for risks factors were recalculated using the VA national electronic health record data, stratified by race (hereafter, VA women model). Our study found a curvilinear association of aging with increased risk of 10-year ASCVD event in VA women starting at ages as young as 30 years across all race groups. The VA women model performance in predicting ASCVD events at 10 years was mixed-moderate in discrimination (C statistics, 0.61–0.64) but good in accuracy, as demonstrated by calibration plots approximating a 45° line. CONCLUSIONS: The study finding, a curvilinear association of aging with increased ASCVD risk in VA women across all races, demonstrates the need for cardiovascular risk screening of younger VA women, aged <45 years.
KW - Cardiovascular risk
KW - Predictive model
KW - Veterans Affairs
KW - Women
KW - Women service members
KW - Women veterans
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U2 - 10.1161/JAHA.120.015087
DO - 10.1161/JAHA.120.015087
M3 - Article
C2 - 32515249
AN - SCOPUS:85086525158
SN - 2047-9980
VL - 9
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 12
M1 - e015087
ER -