Validation of the PREVENT Risk Score for Stroke Among US Hispanic Adults

ABSTRACT Stroke is the fifth leading cause of death in the US but disproportionately impacts ethnic minority populations. Among the over 62 million Hispanic people in the US, stroke represents the third leading cause of death among Hispanic men and the fourth among Hispanic women. In 2023, the American Heart Association developed the Predicting Risk of CVD EVENTs (PREVENT) equations to predict risk of cardiovascular disease, including stroke as an independent outcome. The PREVENT equations are sex-specific but agnostic to race and can be used to estimate ten- and 30-year risk of stroke using both a base model and an enhanced model, which includes information on social determinants of health. Despite this flexibility, the PREVENT equations were developed using a population of primarily non-Hispanic Black and White adults. Though Hispanics constitute the largest ethnic minority population in the US, only 5% of the sample used for the development of the PREVENT equations were of Hispanic ethnicity. Therefore, performance of the PREVENT equation to estimate risk of stroke among US Hispanic adults remains unknown. Within this context, the overall objective of this NIH/NINDS R03 application is to validate the PREVENT risk equation for stroke among US Hispanic adults. To do so, we will leverage data from the Hipanic Community Health Study/Study of Latinos (HCHS/SOL). HCHS/SOL is an ongoing cohort of US Hispanics of diverse backgrounds residing in 4 cities: Bronx, NY; Chicago, IL; Miami, Fl; and San Diego, CA. We will include 4,827 male and 7,919 female participants who were ages 30 to 74 at baseline in 2008-2011 and without prevalent cardiovascular disease. The baseline HCHS/SOL visit included in person collection of clinical measures required for the calculation of stroke risk using the PREVENT equation for stroke. Participants were followed annually for ten years, and stroke events were adjudicated by a panel of expert clinicians. This framework will allow for the execution of the following aims: 1) Estimate the ten- and 30-year risk of stroke among Hispanic adults overall and by sex, Hispanic origin, and nativity, using the PREVENT equation for stroke; and 2) validate the ten-year PREVENT equation for stroke among US Hispanic adults through the assessment of calibration and discrimination. Accurate prediction of stroke risk is critical to its primary prevention. This proposal will evaluate whether the novel PREVENT risk equations for stroke accurately predict stroke among Hispanic adults.