131 - AHA Pediatric Cardiovascular Risk Categories and Cardiovascular-Kidney-Metabolic Syndrome Staging Do Not Predict Baseline Target Organ Injury Risk in Youth with Hypertension: A SUPERHERO Analysis

Publication Number: 131.3723

Andrew M. South, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston Salem, NC, United States; Jessica Fallon. Campbell, Baylor College of Medicine, Houston, TX, United States; Giya Harry, Wake Forest School of Medicine, Winston salem, NC, United States; Margaret Murphy, University of Kentucky College of Medicine, Lexington, KY, United States; Elizabeth A. Onugha, Baylor College of Medicine, Houston, TX, United States; Ashna Pudupakkam, Baylor College of Medicine, Houston, TX, United States; Sandeep Riar, Children's Healthcare of Atlanta, Atlanta, GA, United States; Sahar Siddiqui, Texas Children's Hospital, Houston, TX, United States; Michael J. Walsh, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston-Salem, NC, United States; Carol Vincent, Wake Forest Baptist Health - Brenner Children's Hospital, Winston Salem, NC, United States

Background: Emerging cardiovascular (CV) disease risk assessments such as the recent AHA Scientific Statement on CV Risk Reduction in High-Risk Pediatric Patients and the AHA Presidential Advisory on CV-kidney-metabolic (CKM) syndrome have potential to better identify high risk of CV disease in youth.

Objective: Estimate whether AHA Pediatric CV risk or CKM syndrome predict baseline target organ injury (TOI) in youth with HTN disorders.

Design/Methods: Predictive cross-sectional analysis of baseline data from 7 sites in the Study of the Epidemiology of Pediatric Hypertension (SUPERHERO), a retrospective Registry of electronic health record data. Data were acquired using standardized biomedical informatics scripts and validated by manual record review. Inclusion criteria were youth < 19 years old who received care from subspecialists for HTN disorders from 1/1/2016–12/31/2023 per ICD-10 codes. Exclusion criteria were kidney failure on dialysis, kidney transplantation, or pregnancy by ICD-10 codes; we excluded those with Unclassified AHA risk or CKM syndrome Stage 0. Exposures were AHA risk category (At Risk vs. Moderate Risk vs. High Risk) and CKM syndrome stage (Stage 1 vs. Stage 2), based on ICD-10 codes and recorded BP and BMI. Outcome was TOI by ICD-10 codes. We used bivariate logistic regression models to estimate ROC curves, sensitivity, specificity, and positive and negative predictive values (PPV, NPV).

Results: Of 7,589 participants, 61% were adolescents ≥13 years old and 5% had TOI. AHA risk category prevalence was 79% for Moderate and 14% for High. CKM syndrome prevalence was 20% for Stage 1 and 80% for Stage 2. Both the AHA risk and CKM syndrome models performed poorly (AUC-Risk 0.52, 95% CL 0.49–0.54; AUC-CKM 0.52, 95% CL 0.5–0.54). CKM syndrome Stage 2 (vs. Stage 1) and AHA High Risk and Moderate Risk (both vs. At Risk) had moderate-to-high sensitivity (all ≥67%) and high NPV (all ≥95%) but poor specificity (all < 36%) and PPV (all < 6%).

Conclusion(s): In this analysis of baseline data from youth evaluated for HTN disorders, both worse AHA risk categorization and worse CKM syndrome stage performed poorly at predicting baseline TOI but had high NPV when TOI was uncommon. Ongoing steps in SUPERHERO are focused on validating case definitions of CKM syndrome, AHA risk classification, and TOI. Future SUPERHERO analyses will validate if these CV risk assessments predict treatment response in youth with HTN disorders.