  Guidelines for the management of atherosclerotic cardiovascular disease
(ASCVD) recommend the use of risk stratification models to identify patients
most likely to benefit from cholesterol-lowering and other therapies. These
models have differential performance across race and gender groups with
inconsistent behavior across studies, potentially resulting in an inequitable
distribution of beneficial therapy. In this work, we leverage adversarial
learning and a large observational cohort extracted from electronic health
records (EHRs) to develop a "fair" ASCVD risk prediction model with reduced
variability in error rates across groups. We empirically demonstrate that our
approach is capable of aligning the distribution of risk predictions
conditioned on the outcome across several groups simultaneously for models
built from high-dimensional EHR data. We also discuss the relevance of these
results in the context of the empirical trade-off between fairness and model
performance.
