Now, the American Heart Association is trying to remove race from the equation.
The scientists who modified the algorithm found that race itself is not a medically accepted proxy for certain social conditions, genetic predispositions, or environmental exposures that increase the risk of cardiovascular disease. It was determined from the beginning that it did not belong to a clinical tool for guiding decision-making. disease.
The revisions come amid growing concerns about health equity and racial bias in the U.S. health care system and are part of a broader trend to exclude race from various clinical algorithms.
“Race should not be used to inform whether someone should or should not receive treatment,” said Preventive Cardiologist at Northwestern University Feinberg School of Medicine and chair of American Heart magazine’s statement writing committee. said Dr. Sadiya Khan. Association, or AHA
The statement was published Friday in the association’s journal, Circulation. An online calculator using a new algorithm called PREVENT is still under development.
Dr. Khan said that “race is a social construct,” and that including race in the clinical equation “implies that it is a biological predictor and has the potential to cause significant harm.” Yes,” he added.
That doesn’t mean black Americans aren’t at higher risk of dying from cardiovascular disease than white Americans, she says. They are, she added, and the life expectancy of black Americans is similarly short.
But Dr. Khan said race has been used in algorithms as a proxy for a variety of factors that work against black Americans. It’s not clear to scientists what the risks are in all this. Once they are better understood, “we can work to address and fix them,” she said.
Cardiac risk assessment has also improved in several other important ways. This algorithm can be used by someone as young as 30 years old and estimates her 10-year and her 30-year total cardiovascular risk, unlike previous algorithms that were only valid for people over 40 years old.
This assessment has been redesigned for the first time to estimate an individual’s risk of developing heart failure, as well as heart attack and stroke. This is important because heart failure has increased in recent years due to an aging population and high obesity rates. This condition can lead to a serious reduction in quality of life.
The new calculator also takes kidney function into account for the first time when predicting risk, as kidney disease increases the risk of heart disease, heart attack, heart failure and stroke.
In recent years, there has been increasing recognition that there is a strong link between cardiovascular disease, kidney disease, and metabolic diseases (such as type 2 diabetes and obesity). Last month, the association’s scientific advisors defined a new disease called cardiovascular-kidney-metabolic syndrome (CKM).
“CKM is associated with significant premature mortality, primarily from cardiovascular disease,” said Dr. Chiadi Ndumele, a cardiologist at Johns Hopkins School of Medicine and author of the new scientific statement.
“If there are social determinants that negatively impact health, they are disproportionately present, including the social contexts in which we eat, work, learn, and play,” he said. I did.
The new equation also has the option of including a measure of blood sugar control called hemoglobin A1C in people with type 2 diabetes, as well as a factor called the social deprivation index, which includes poverty, unemployment, education and other factors.
The change is “great news,” said Dr. David S. Jones, a psychiatrist and professor of medical history at Harvard University. He wrote a paper published in News about the use of race in myriad medical decision-making algorithms. British Medical Journal 2020.
The paper explores how race plays a role in a wide range of clinical algorithms used to make medical decisions for conditions as diverse as urinary tract infections, vaginal delivery after caesarean section, breast cancer, and lung and kidney function. Explained how it has been used.
“It’s very gratifying to see how medical thinking on this issue has changed over the past three to five years,” Dr. Jones said.
There are racial disparities in many health measures, but scientists need to conduct research to understand exactly what causes those differences, he said, adding, “We can’t simply divide the world into blacks and whites. “You can’t say that all white people are like that,” he added. If we have this, all black people can have it. ”
However, he said implementing changes can be difficult.
Two years ago, the National Kidney Foundation and American Society of Nephrology Scientific Task Force called for the elimination of kidney function measurements that adjust results by race, resulting in Black patients being sicker than they actually are. It often appeared mild and often led to a delay in treatment.
Within 18 months, about 65% of all testing facilities had adopted the new approach, said Dr. Neil Pauw, medical director at Zuckerberg San Francisco General Hospital and professor of medicine at the University of California, San Francisco.
Dr. Pau said he shares the concerns raised by the authors of the AHA’s scientific statement. “What exactly is at the root of racial health disparities?”
“As I have said many times, more research needs to be done to understand what kind of races are being captured and what their replacements are.”
Many physicians do not know whether or to what extent their patients experience social stressors that impact their health. For example, studies on maternal mortality show that wealth and higher education do not compensate for the health risks associated with being black in America.
The wealthiest mothers and their babies are most likely to survive a year after giving birth, but a California study found that the same was not true for black women. The wealthiest black mothers and their babies are twice as likely to die as the wealthiest white mothers. mother and her baby.
