Opinion
EDITORIAL
JAMA Cardiology: A New Cardiovascular Journal
Robert O. Bonow, MD, MS
The accelerating pace of cardiovascular science and practice
provides new opportunities for prevention, diagnosis, and
treatment, along with the hope of a better future for individu-
als with heart disease and
those at risk of disease. At the
Author Audio Interview at same time, there are press-
jamacardiology.com ing challenges; aging of the
population, the persistent
burden of risk factors, health care disparities, and the emer-
gence of cardiovascular disease in low- and middle-resource
countries present challenges that may slow the potential
benefit of these advances. 1-3 Gaps in knowledge and the
variability in resource use and implementation of proven
interventions4-7 underscore the need for ongoing research and
education.
To address the growing need for science discovery and
dissemination, JAMA Cardiology has arisen as the newest
member of the JAMA Network of journals. With weekly
Online First publication and monthly issues in print and
online, JAMA Cardiology will publish the findings of impor-
tant research as Original Investigations, including clinical
trials and meta-analyses, Brief Reports, and Research
Letters, along with scholarly Reviews and timely opinion
articles by thought leaders in the form of Viewpoints, Invited
Commentaries, and Editorials. The journal will focus on all
aspects of cardiovascular medicine, including hypertension,
ischemic heart disease, heart failure, stroke, valvular heart
disease, rhythm disorders, peripheral artery disease, cardiac
critical care, and resuscitation science. We will publish
articles in the disciplines of genetics, epidemiology and pre-
vention, diagnostic testing and imaging, interventional and
pharmacologic therapeutics, translational research, health
care policy and outcomes, and global health. In addition to
cutting-edge research investigations and state-of-the art
reviews, practical clinical information will include guide-
lines synopses, evidence reviews, and clinical challenges,
and many of our articles will offer our readers continuing
medical education. The vision for JAMA Cardiology is to
serve both the research and clinical communities and
become the definitive journal for cardiovascular investiga-
tors, clinicians, and trainees throughout the world.
A taste of the content to be found in future issues of the
journal is represented in this week’s inaugural Online First
issue. Fox and colleagues8 from the National Heart, Lung,
and Blood Institute–sponsored Jackson Heart Study examine
prediction models for major cardiovascular events in African
American individuals. The report of this seminal study is
accompanied by an editorial by Goff and Lloyd-Jones,9 who
discuss the implications of this study in light of the 2013
jamacardiology.com
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American College of Cardiology/American Heart Association
pooled risk equations for estimating atherosclerotic disease
risk. Anderson and coinvestigators 10 from the American
Heart Association’s Get With the Guidelines–Resuscitation
group report outcomes of patients with in-hospital cardiac
arrest according to adherence to process measures of quality
of care for in-hospital cardiac arrest. Engel et al11 and the
accompanying commentary by Baggish12 provide unique
insights into the effects of long-term, intense exercise condi-
tioning on cardiac structure and function in more than 500
professional athletes in the National Basketball Association.
These data from highly trained athletes, whose height and
body surface area greatly exceed those of participants in pre-
vious reports on athletic conditioning, extend the knowl-
edge base on the extremes of normal cardiac remodeling.
Our first online issue also includes a provocative Viewpoint
from Pfeffer and Braunwald 1 3 on the all-too-common
conundrum of heart failure with preserved systolic function
and its treatment.
JAMA Cardiology assigns a high priority to serving our
authors. Our goal is to provide initial review of submitted
manuscripts within 3 to 5 days and complete external peer
review in 4 to 5 weeks. Articles accepted for publication will
appear Online First approximately 2 months after accep-
tance, followed by publication in a formal monthly issue in
print and online. The association with the JAMA family of
journals via The JAMA Network links JAMA Cardiology with
tremendous resources, extensive physician reach, exposure
to colleagues in diverse fields, and cutting-edge electronic
platforms. Our online and print presence is enhanced by
constantly growing social media and multimedia visibility,
with posts on Twitter and Facebook, email alerts with elec-
tronic tables of contents and links to articles, and global out-
reach to news media that will promote rapid and extensive
dissemination of JAMA Cardiology content worldwide. All
research articles will be freely accessible 12 months after
publication and all of the content of JAMA Cardiology (along
with that of JAMA and the other JAMA Network journals)
will be available free on the JAMA Network Reader. In addi-
tion, authors of research articles have the option to pay for
immediate open access.14
The outstanding editorial team of JAMA Cardiology
includes deputy editors Robert Harrington, MD, Clyde Yancy,
MD, MSc, Marc Sabatine, MD, MPH, and Michael Pencina,
PhD. Our associate editors are Adrian Hernandez, MD, MHS,
Christopher O’Donnell, MD, MPH, Gregg Fonarow, MD,
Elizabeth McNally, MD, PhD, Mark Huffman, MD, MPH,
Sanjiv Shah, MD, Mintu Turakhia, MD, MAS, and Laine
Thomas, PhD. Our team has years, breadth, and depth of
(Reprinted) JAMA Cardiology April 2016 Volume 1, Number 1 11
 Opinion Editorial

research and clinical experience. We share the everyday resource for us all. Together, with our authors and our read-
challenges facing clinicians and the patients they serve, and ers, we can advance science, inform the practice of cardio-
we are also connected to the rapidly expanding research vascular medicine to improve the lives of patients with car-
enterprise. We will build a journal that is an essential diovascular disease, and enhance the health of those at risk.

ARTICLE INFORMATION
Author Affiliations: Department of Medicine,
Northwestern University Feinberg School of
Medicine, Chicago, Illinois; Editor, JAMA Cardiology.
Corresponding Author: Robert O. Bonow, MD, MS,
Department of Medicine, Northwestern University
Feinberg School of Medicine, 251 E Huron St,
Galter 3-150, Chicago, IL 60611
(r-bonow@northwestern.edu).
3. Mozaffarian D, Benjamin EJ, Go AS, et al. Heart
disease and stroke statistics—2016 update: a report
from the American Heart Association [published
online December 16, 2015]. Circulation.
4. Peterson ED, Roe MT, Mulgund J, et al.
Association between hospital process performance
and outcomes among patients with acute coronary
syndromes. JAMA. 2006;295(16):1912-1920.
5. Fonarow GC, Abraham WT, Albert NM, et al;
February 24, 2016]. JAMA Cardiol. doi:10.1001
/jamacardio.2015.0323.
10. Anderson ML, Nichol G, Dai D, et al; American
Heart Association’s Get With the Guidelines–
Resuscitation Investigators. Association between
hospital process composite performance and
patient outcomes after in-hospital cardiac arrest
care [published online February 24, 2016]. JAMA
Cardiol. doi:10.1001/jamacardio.2015.0275.

Published Online: February 24, 2016.
doi:10.1001/jamacardio.2015.0358.
Conflict of Interest Disclosures: The author has
completed and submitted the ICMJE Form for
Disclosure of Potential Conflicts of Interest and
none were reported.
REFERENCES
1. Murray CJ, Atkinson C, Bhalla K, et al; US Burden
of Disease Collaborators. The state of US health,
1990-2010: burden of diseases, injuries, and risk
factors. JAMA. 2013;310(6):591-608.
2. Global Burden of Disease Study 2013
Collaborators. Global, regional, and national
incidence, prevalence, and years lived with
disability for 301 acute and chronic diseases and
injuries in 188 countries, 1990-2013: a systematic
analysis for the Global Burden of Disease Study
2013. Lancet. 2015;386(9995):743-800.
OPTIMIZE-HF Investigators and Hospitals.
Association between performance measures and
clinical outcomes for patients hospitalized with
heart failure. JAMA. 2007;297(1):61-70.
6. Matlock DD, Groeneveld PW, Sidney S, et al.
Geographic variation in cardiovascular procedure
use among Medicare fee-for-service vs Medicare
Advantage beneficiaries. JAMA. 2013;310(2):155-162.
7. Newhouse JP, Garber AM. Geographic variation
in health care spending in the United States:
insights from an Institute of Medicine report. JAMA.
2013;310(12):1227-1228.
8. Fox ER, Samdarshi TE, Musani SK, et al.
Development and validation of risk prediction
models for cardiovascular events in black adults:
the Jackson Heart Study cohort [published online
February 24, 2016]. JAMA Cardiol. doi:10.1001
/jamacardio.2015.0300.
9. Goff DC Jr, Lloyd-Jones DM. The pooled cohort
risk equations—black risk matters [published online
11. Engel DJ, Schwartz A, Homma S. Athletic cardiac
remodeling in US professional basketball players
[published online February 24, 2016]. JAMA Cardiol.
doi:10.1001/jamacardio.2015.0252.
12. Baggish AL. Cardiac variables in professional
basketball players: looking closely at the Normal Big
Athlete (NBA) [published online February 24, 2016].
JAMA Cardiol. doi:10.1001/jamacardio.2015.0289.
13. Pfeffer MA, Braunwald E. Treatment of heart
failure with preserved ejection fraction: reflections
on its treatment with an aldosterone antagonist
[published online February 24, 2016]. JAMA Cardiol.
doi:10.1001/jamacardio.2015.0356.
14. JAMA Cardiology Instructions for Authors.
JAMA Cardiology website. http://cardiology
.jamanetwork.com/forauthors.html. Accessed
January 16, 2016.

The Pooled Cohort Risk Equations—Black Risk Matters

David C. Goff Jr, MD, PhD; Donald M. Lloyd-Jones, MD, ScM

Dating from the 27th Bethesda Conference1 in 1996, there has
been a consensus in the preventive cardiology community that
the intensity of preventive interventions should be matched
to an individual’s absolute
level of risk of development of
Related article page 15 atherosclerotic cardiovascu-
lar disease (ASCVD). This con-
sensus was reflected in the adoption of the Framingham Risk
Score (FRS) for estimating the 10-year risk of a hard coronary
heart disease (CHD) event by the National Cholesterol Educa-
tion Program’s 2001 Adult Treatment Panel (ATP III) in their
executive summary 2 and by the adoption of the Pooled
Cohort risk equations (PCEs) for estimating the 10-year risk of
a hard ASCVD event3 by the American College of Cardiology
and the American Heart Association in their 2013 guideline on
the treatment of blood cholesterol to reduce atherosclerotic
cardiovascular risk in adults.4
The ability to estimate risk accurately in African Ameri-
cans is particularly important because they are a higher-risk
population. In comparison with non-Hispanic white popula-
tions, African Americans have 2 to 3 times the risk of stroke,
2 times the risk of heart failure (HF), and 1.5 to 2 times the
risk of CHD. 5 Failure to recognize this high-risk status
could lead to missed opportunities for prevention. Hence,
black risk matters.
The PCEs, validated by Muntner et al6 in a large contem-
porary cohort of community-dwelling African Americans
and whites in the United States, were adopted by the Ameri-
can College of Cardiology and the American Heart Associa-
tion in 2013 as an improvement on the older FRS for CHD for
several reasons. First, the PCEs included stroke and ASCVD
death among the outcomes of interest for prevention,
expanding beyond the narrower focus of the FRS on myocar-
dial infarction and CHD death only by including stroke, an
outcome of substantial importance to African Americans.
Second, by pooling data from multiple community-based
cohorts, the PCEs derived risk estimation algorithms specific
to African Americans and potentially more applicable to
African Americans than the FRS, derived from a white
cohort in a single community. Third, and also related to the
use of multiple cohorts, the PCEs might be more widely
applicable to white populations across the United States.

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