Abstract
Quantifying the risk of cardiovascular disease (CVD) in a community is important in planning preventive strategies, but such data are limited from developing countries, especially South Asia. We aimed to estimate the risks of coronary heart disease (CHD), total CVD, and CVD mortality in a Sri Lankan community. A community survey was conducted in an urban health administrative area among individuals aged 35-64 years, selected by stratified random sampling. Their 10-year CHD, total CVD, and CVD mortality risks were estimated using three risk prediction tools: National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III), Systematic Coronary Risk Evaluation (SCORE), and World Health Organisation/ International Society of Hypertension (WHO/ISH) charts. Among study participants (n=2985), 54.5% were females, and mean age (SD) was 52.4 (7.8) years. According to NCEP-ATP III ('hard' CHD risk), WHO/ISH (total CVD risk), and SCORE (CVD mortality risk) criteria, 25.4% (95% CI 23.6-27.2), 8.2% (95% CI 7.3-9.2), and 11.8 (95% CI 10.5-13.1) respectively were classified as at 'high risk'. The proportion of high risk participants increased with age. 'High risk' was commoner among males (30.3% vs 20.6%, p<0.001) according to NCEPATP III criteria, but among females (9.7% vs. 6.7%, p<0.001) according to WHO/ISH criteria. No significant gender difference was noted in SCORE risk categories. A large proportion of individuals in this community are at risk of developing cardiovascular diseases, especially in older age groups. Risk estimates varied with the different prediction tools, and were comparatively higher with NCEP-ATP III charts.
Highlights
Cardiovascular diseases (CVD) is the leading cause of mortality in the world [1,2]
According to NCEP-ATP III (‘hard’ coronary heart disease (CHD) risk), World Health Organisation/ International Society of Hypertension (WHO/ISH), and Systematic Coronary Risk Evaluation (SCORE) (CVD mortality risk) criteria, 25.4%, 8.2%, and 11.8 respectively were classified as at ‘high risk’
Risk estimates varied with the different prediction tools, and were comparatively higher with NCEP-ATP III charts
Summary
Cardiovascular diseases (CVD) is the leading cause of mortality in the world [1,2]. The broad disease category CVD comprises atherosclerosis related coronary heart disease (CHD), stroke and peripheral vascular disease. The burden of CVD is especially high in South Asia, where the prevalence and incidence of CVD, mortality due to CVD, and the prevalence of risk factors of CVD are higher than in many other regions [4,5]. This increase is seen among those resident in South Asia, and in migrant South Asian communities in Western countries [6,7]. The community prevalence of CHD in Sri Lanka is estimated to be 9.3%, and prevalence of stroke in the Colombo district is 1.04% [8, 9]. CHD and stroke together account for 23% of hospital deaths in Sri Lanka [10]
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