![]() ![]() PCE were developed to expand on prior cardiovascular disease risk prediction equations 5 - 7 in a racially and geographically diverse sample. The ASCVD Risk Estimator Plus is based on the 2013 American College of Cardiology/American Heart Association Guideline on the Assessment of Cardiovascular Risk and its corresponding sex- and race-specific pooled cohort equations (2013 PCE) for estimation of 10-year ASCVD risk. 3 Thus, years since quitting (YSQ) and pack-years smoked may play an important role in ASCVD risk estimation. However, we recently demonstrated that excess ASCVD risk among former heavy (≥20 pack-years) smokers vs never smokers can remain for up to 16 years postcessation. ![]() 1, 2 This calculator considers former smokers, for the first 5 years after cessation, to be at excess ASCVD risk compared with never smokers and does not incorporate pack-years smoked. The cornerstone of atherosclerotic cardiovascular disease (ASCVD) prevention is assessing risk prior to an event and implementing lifestyle and drug interventions accordingly the current criterion standard risk assessment tool is the ASCVD Risk Estimator Plus. If results are validated in cohorts of race and ethnicity groups other than White, these variables could be considered for inclusion in future ASCVD risk prediction models. The Framingham Heart Study offspring cohort is largely composed of non-Hispanic White participants of European ancestry. Including former smoking status, pack-years, and years since quitting had significant but modest NRI(>0) and rIDI values compared with the PCE with continuous variables on their natural scale in both sexes (men: NRI = 0.23 rIDI = 0.19 women: NRI = 0.34, rIDI = 0.11 change in C statistic = 0.01 for both).Ĭonclusions and Relevance Former smoking, pack-years, and years since quitting significantly improved ASCVD risk prediction in this sample. Models were compared via change in C statistic, continuous net reclassification improvement (NRI), and relative integrated discrimination improvement (rIDI). The PCEs were was fit in this sample with continuous predictors on their natural scale (ie, not logarithmically transformed) as well as polynomials accounting for nonlinearity and then cumulatively adjusted for former smoking, pack-years, and years since quitting. Four sex-specific ASCVD risk prediction models were built using pooled-repeated Cox proportional hazards regression. Ever smoking prevalence was high (6474 men and 7760 women ), as were median pack-years (men: 39 women: 32 overall person examinations). Results Of 3908 patients, there were 358 and 197 events among 1895 men and 2013 women, respectively, with a mean (SD) age of 55 (9.5) years. Main Outcomes and Measures Incident ASCVD (myocardial infarction, fatal/nonfatal ischemic stroke, coronary heart disease death). Framingham Heart Study offspring cohort participants attending their first examination (1971-1975) who were followed-up through December 2016 were included.Įxposures Self-reported current/former/never smoking status, pack-years smoked, and years since quitting. Objective To assess the predictive utility of smoking history when added to the PCE using data from 18 400 person examinations among Framingham offspring participants.ĭesign, Setting, and Participants This is a retrospective analysis of prospectively collected data from the Framingham Heart Study, a community-based cohort. However, the 2013 pooled cohort equations (PCE) do not account for pack-years of smoking and only consider current vs noncurrent smoking status without distinguishing former smokers from never smokers. Importance Former heavy smokers (ie, those with ≥20 pack-years of smoking) may have higher atherosclerotic cardiovascular disease (ASCVD) risk than never smokers for up to 16 years after smoking cessation.
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