Abstract P102: Comparison Of Existing Cardiovascular Risk Prediction Models In Haiti: Implications For Primary Prevention In Lower-income Countries

Abstract

Introduction: Cardiovascular diseases (CVD) are rapidly increasing in low-middle income countries. Accurate risk assessment is essential to reduce premature CVD by targeting primary prevention. Available CVD risk prediction models are built on predominantly Caucasian, high-income country populations, and have not been evaluated in lower-income countries. We aimed to compare six existing models for predicted 10-year risk of CVD and identify high-risk groups for targeted prevention in Haiti. Methods: We used cross-sectional data within the Haiti CVD Cohort Study, including 653 adults ≥ 40 years without known history of CVD. Six CVD risk prediction models were compared: pooled cohort equations (PCE), adjusted PCE with updated cohorts, Framingham CVD Lipids, Framingham CVD Body Mass Index (BMI), WHO Lipids, and WHO BMI. Risk factors were measured during clinical exams. Primary outcome was continuous and categorical predicted 10-year CVD risk. Secondary outcome was statin eligibility. Results: Seventy percent (460/653) were female, 65.5% (428/653) lived on a daily income of ≤1 USD, 57.0% (372/653) had hypertension, 14.5% (95/653) had hypercholesterolemia, 9.3% (61/653) had diabetes mellitus, and 5.5% (36/653) were current smokers. Predicted 10-year CVD risk ranged from 3.9% in adjusted PCE (IQR 1.7-8.4) to 9.8% in Framingham-BMI (IQR 5.0-17.8), and Spearman correlation coefficients ranged from 0.87 to 0.98. The percent of the cohort categorized as high risk using the uniform threshold of 10-year CVD risk ≥ 7.5% ranged from 28.8% in the adjusted PCE model to 62.0% in the Framingham-BMI model (χ 2 = 331, p value < 0.001). Statin eligibility also varied widely. Conclusions: In the Haiti CVD Cohort, there was substantial variation in the proportion identified as high-risk and statin eligible using existing models, leading to very different treatment recommendations and public health implications depending on model choice. There is a need to design and validate CVD risk prediction tools for low-middle income countries.