Clinical Edge

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Evaluating ASCVD Risks Among US Women

JAMA Intern Med; ePub 2018 Jul 23; Mora, et al

Observed and predicted atherosclerotic cardiovascular disease (ASCVD) risks among women were better aligned after including ASCVD events from the Centers for Medicare and Medicaid Services (CMS) claims, a recent study found. Researchers evaluated the predictive accuracy of the Pooled Cohort Equations (PCE) in the Women’s Health Initiative (WHI), a multiethnic cohort of contemporary postmenopausal women. They evaluated the effects of time-varying treatments such as aspirin and statins, and ascertainment of additional ASCVD events by linkage with CMS claims. They found:

  • 19,995 women (mean age 64 years; 41.5% white, 38.5% black, 17.5% Hispanic, 0.5% American Indian, 1.6% Asian/Pacific Islander, and 0.4% unknown).
  • Observed ASCVD risks were generally lower than predicted by PCE with adjustment for changes in statin and aspirin use resulting in small increased in observed risks.
  • WHI-adjusted risks were also lower than predicted but observed (predicted) risks became aligned after including events ascertained by linkage with CMS for additional surveillance for events.
  • Similar results were seen across ethnic/racial groups.


Mora S, Wenger NK, Cook NR, et al. Evaluation of the pooled cohort risk equations for cardiovascular risk prediction in a multiethnic cohort from the Women’s Health Initiative. [Published online ahead of print July 23, 2018]. JAMA Intern Med. doi:10.1001/jamainternmed.2018.2875.

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