Letters

4. Kocher R, Emanuel EJ, DeParle NA. The Affordable Care Act and the future of clinical medicine: the opportunities and challenges. Ann Intern Med. 2010;153 (8):536-539. 5. Hussey PS, Ridgely MS, Rosenthal MB. The PROMETHEUS bundled payment experiment: slow start shows problems in implementing new payment models. Health Aff (Millwood). 2011;30(11):2116-2124. 6. Shortell SM, Casalino LP, Fisher ES. How the center for Medicare and Medicaid innovation should test accountable care organizations. Health Aff (Millwood). 2010;29(7):1293-1298. 7. Hulkower R. The history of the Hippocratic oath: outdated, inauthentic, and yet still relevant. Einstein J Biol Med. 2010;25/26:2009-2010.

Trends in Predicted Risk for Atherosclerotic Cardiovascular Disease Using the Pooled Cohort Risk Equations Among US Adults From 1999 to 2012 Risk assessment has become an important tool to assess an individual’s future risk for cardiovascular disease. Recently, the American College of Cardiology/American Heart Association (ACC/AHA) released a report that presented updated risk equations, the Pooled Cohort Risk Equations, for cardiovascular disease.1 Race and ethnicity-specific estimates were novel to

the new risk equations. Because changes over time in predicted cardiovascular risk using these new risk equations have not been examined, our objectives were to (1) examine the trend in predicted 10-year cardiovascular risk using the new ACC/AHA Pooled Cohort Risk Equations and (2) estimate the potential for risk reduction by optimizing levels of cardiovascular risk factors. Methods | We used data from seven 2-year cycles of the National Health and Nutrition Examination Survey (1999-2000 to 2011-2012) that includes nationally representative samples of the US population selected with a complex multistage sampling design.2 Response rates for the interview and examination stages all exceeded 70%. The surveys were approved by the National Center for Health Statistics Research Ethics Review Board. We used the Pooled Cohort Risk Equations to calculate predicted 10-year cardiovascular risk1 and limited the analyses to men and nonpregnant women who were aged 40 to 79 years and free of self-reported congestive heart failure, coronary heart

Table 1. Cardiovascular Risk Factors and Unadjusted Distribution of Predicted 10-Year Risk for Cardiovascular Disease (CVD) Among US Adults Aged 40 to 79 Years Without Self-reported CVDa Variable

1999-2000 (n = 1965)

2001-2002 (n = 2176)

2003-2004 (n = 1984)

2005-2006 (n = 2011)

2007-2008 (n = 2703)

2009-2010 (n = 2864)

2011-2012 (n = 2404)

P Value for Trend

Age, mean (SE), y Total

54.3 (0.4)

53.5 (0.2)

53.8 (0.3)

54.1 (0.6)

54.4 (0.3)

54.8 (0.2)

55.1 (0.3)

.002

NHW

54.8 (0.5)

54.0 (0.3)

54.2 (0.4)

54.7 (0.7)

54.9 (0.4)

55.5 (0.3)

55.8 (0.3)

.002

NHB

52.5 (0.4)

52.0 (0.7)

52.9 (0.6)

53.0 (0.5)

53.5 (0.4)

53.9 (0.5)

54.1 (0.5)

.001

MA

51.2 (0.5)

50.6 (0.9)

51.2 (0.8)

51.3 (0.5)

51.8 (0.8)

51.8 (0.5)

50.6 (0.7)

.75

Current smoker, % (SE) Total

20.6 (1.6)

20.5 (1.1)

22.1 (1.2)

22.2 (1.6)

19.8 (1.7)

17.1 (1.1)

19.1 (0.9)

.045

NHW

19.5 (1.8)

18.8 (1.5)

20.9 (1.2)

21.4 (2.2)

19.5 (2.4)

15.7 (1.4)

19.3 (1.1)

.31

NHB

31.3 (3.3)

29.7 (2.7)

29.3 (2.9)

27.0 (2.5)

25.8 (2.2)

28.7 (4.0)

22.0 (2.6)

.04

MA

20.8 (2.6)

21.5 (1.5)

20.6 (2.4)

19.0 (1.8)

16.9 (2.5)

17.8 (1.9)

18.5 (3.1)

.19

TC, mean (SE), mg/dL Total

214.3 (1.9)

211.7 (1.5)

209.8 (1.5)

207.1 (1.1)

205.2 (1.3)

205.9 (1.7)

205.0 (1.3)