Abstract
The goal of this analysis was to determine the agreement between body mass index-based and cholesterol-based ten-year Framingham general cardiovascular disease risk scores among a convenience sample of 773 South Asian Canadian adults attending community-based screening clinics. Scores were calculated using age, systolic blood pressure, antihypertensive use, current smoking, diabetes, and total cholesterol and high density lipoprotein (for cholesterol-based risk) or height and weight (for body mass index-based risk). Mean risk score differences (body mass index-based risk minus cholesterol-based risk) were estimated using paired t-tests. Bland-Altman plots were used to assess agreement between scores. Finally, agreement across risk categories (low [<10%], moderate [10% to <20%], high [> = 20%]) was examined using the kappa statistic. Average agreement between the two risk scores was quite good overall (mean differences of 0.6% for men and 0.5% for women), but increased to about 3% among participants 60–74 years of age. However, Bland-Altman plots revealed that the differences between the two scores and the variability of the differences increased with increasing average 10-year risk. In terms of clinical importance, the limits of agreement were reasonable for women < 60 years (95% confidence interval: -3.2% to 3.1%), but of concern for women 60-74 years (95% confidence interval: -6.0% to 12.3%), men < 60 years (95% confidence interval: -7.1% to 7.3%) and men 6-074 years (95% confidence interval: -13.8% to 18.8%). Agreement across categories was moderate for most sex and age groups examined (kappa values: 0.51 for women < 60 years, 0.50 for women 60-74 years, 0.65 for men < 60 years), except for men 60-74 years, where agreement was only fair (kappa = 0.26). In light of these disagreements, evaluation of a participant’s change in cardiovascular disease risk over time will necessitate use of the same risk score (i.e., either body mass index-based or cholesterol-based) at all screening sessions.
Highlights
Heart disease and stroke are the second and third leading causes of death in Canada, responsible for 21% and 6% of all deaths, respectively [1]
Despite the fact that national administrative data on cardiovascular disease (CVD) mortality and morbidity by ethnicity are not available in Canada, it has been estimated that ischemic heart disease mortality rates among men and women of South Asian (SA) origin are 3 and 3.6 times higher, respectively, than rates among men and women of Chinese origin [2]
The majority of participants were not born in Canada, but of those, about half had lived in Canada for longer than 20 years (Table 1)
Summary
Heart disease and stroke are the second and third leading causes of death in Canada, responsible for 21% and 6% of all deaths, respectively [1]. Despite the fact that national administrative data on cardiovascular disease (CVD) mortality and morbidity by ethnicity are not available in Canada, it has been estimated that ischemic heart disease mortality rates among men and women of South Asian (SA) origin are 3 and 3.6 times higher, respectively, than rates among men and women of Chinese origin [2]. Community-based screening for CVD risk, shown to be feasible in a variety of SA community settings [8,9,10], may engage those who do not or cannot access primary care services. Continuing our pilot work [8], we have partnered with SA communities across Canada to provide a culturally appropriate, accessible and sustainable CVD screening and support program. Participants have completed baseline screening and will be re-screened after one year to assess change in CVD risk
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