Updated on November 17, 2023.
For the first time in 10 years, the American Heart Association (AHA) updated the tool used to predict someone’s long-term risk of developing heart disease. The new calculator called PREVENT (Predicting Risk of cardiovascular disease EVENTs) includes broader measures of health and variables, such as a person's age and sex—but eliminates race as risk factor for heart disease.
The tool excludes race because using it as a biological variable in medical decisions may actually worsen racial health disparities (preventable differences in the quality of health, health care, and health outcomes experienced by certain groups), the AHA explains. It may perpetuate biases among healthcare providers, contribute to disease stereotyping, and alter clinical care algorithms. It may also promote the false theory that certain racial groups share biological traits that make them genetically more prone to disease.
Why race is not a valid predictor
The completion of the Human Genome Project in 2003 (an international research project that sequenced more than 90 percent of the human genome) confirmed humans are 99.9 percent identical at the DNA level. Bottom line: there is no genetic basis for race.
Scientists have long understood that race is a social construct—an idea that is created and generally accepted by people in a society. In its least harmful application, race may be used to classify groups of people according to cultural or other differences. But in its most toxic and misguided application, it has been used to assign value to certain groups and engineer a social hierarchy, according to a 2021 systematic review published in Evolution, Medicine & Public Health.
Racism has profound effects on people’s health and well-being. Its effects are “perhaps the most pervasive, widespread, and long-lasting,” a January 2022 research article published in Circulation: Cardiovascular Quality and Outcomes. To a significant degree, skin color determines a person’s risk of disease and death. People of color, including Black, Hispanic, American Indian, Asian, and others, experience a range of social disadvantages that place them at higher risk for heart disease, poor health outcomes, and death, the article explains. The researchers note that disparities in heart disease are among the most obvious “reminders of social injustices, and racial inequities, which continue to plague our society.”
Black people are more likely to die from heart disease
Heart disease kills more than 650,000 people in the U.S. each year. Black adults are disproportionately affected and more than twice as likely to die from the condition than their white peers. An accumulation of evidence points to deeply rooted structural racism and differences in social determinants of health (SDOH)—the conditions in which people are born, grow, work, live, and age—as underlying causes of this health disparity.
For example, socioeconomic status is a main determinant of heart disease. Historically, Black, Hispanic, and other underserved communities are more likely to have lower incomes, to be unemployed, or earn less than their white counterparts despite having the same level of expertise. This can affect their ability to access education, quality care, as well as safe and affordable housing.
Being socioeconomically disadvantaged may force people to live in neighborhoods with limited access to parks or other green spaces, which reduces opportunities for physical activity. There may be transportation barriers that prevent people from traveling to markets for healthy food options, or hospitals where they can receive care. Lower income neighborhoods may also increase people’s exposure to air pollution, including fine particulate matter, which is tied to a greater risk for heart disease.
Barriers to education not only affect employment opportunities, but also reduce health literacy and knowledge about healthy behaviors and risk factors for heart disease. Less economic stability and a reduced sense of personal control also contributes to a higher risk for depression, negative coping behaviors (smoking, heavy drinking, drug use), high blood pressure, and diabetes—all of which may contribute to the development of heart disease.
Taking social factors into account
The AHA’s updated risk model was developed using data from more than six million U.S. adults from a range of racial and ethnic, socioeconomic, and geographic backgrounds.
It now takes cardiovascular-kidney-metabolic syndrome (CKM) into account. This condition, which was first defined in October 2023, affects nearly all major organs, including the brain, heart, kidneys, and metabolism. The updated tool rethinks how the overlapping effects of obesity, type 2 diabetes, chronic kidney disease, and heart disease, predict long-term cardiovascular risks.
PREVENT includes a measure for predicting heart failure. It also factors in blood pressure and cholesterol levels, tobacco use, age, sex, and whether people take medications. It assesses people ages 30 to 79 (10 years earlier than before) and can predict the risk for heart attack, stroke, and heart failure over a 10 and 30-year time span.
While it excludes race as a biological factor, PREVENT does have an option to include an index that incorporates social determinants of health, such as education, poverty, and employment status.
"We also acknowledge that racism, and not race, operates at multiple levels to increase risk" for cardiovascular disease, said Sadiya S. Khan, M.D., chairperson of the committee that wrote the statement in a November 10 news release, noting that more research is needed to determine the factors that underly racial differences in health risks and outcomes.
Going forward, the AHA recommends that the inclusion of measures that represent individual experiences of discrimination as well as structural and systemic racism should also be a priority in risk prediction for heart disease.
