Abstract
BackgroundPrediction of absolute risk of cardiovascular diseases (CVDs) has important clinical and public health significance, but the predictive ability of the available tools has not yet been tested in the rural Bangladeshi population. The present study was undertaken to test the hypothesis that both laboratory-based (Framingham equation and WHO/ISH laboratory-based charts) and non-laboratory-based tools may be used to predict CVDs on a short-term basis.MethodsData from a case-cohort study (52989 cohort and 439 sub-cohort participants), conducted on a rural Bangladeshi population, were analysed using modified Cox PH model with a maximum follow-up of 2.5 years. The outcome variable, coronary heart diseases (CHDs), was assessed in 2014 using electrocardiography, and it was used as a surrogate marker for CVDs in Bangladesh. The predictive power of the models was assessed by calculating C-statistics and generating ROC curves with other measures of diagnostic tests.ResultsAll the models showed high negative prediction values (NPVs, 84 % to 92 %) and these did not differ between models or gender. The sensitivity of the models substantially changed based on the risk prediction thresholds (between 5–30 %); however, the NPVs and PPVs were relatively stable at various threshold levels. Hypertension and dyslipidaemia were significantly associated with CHD outcome in males and ABSI (a body shape index) in females. All models showed similar C-statistics (0.611–0.685, in both genders). Overall, the non-laboratory-based model showed better performance (0.685) in women but equal performance in men.ConclusionsExisting CVD risk prediction tools may identify future CHD cases with fairly good confidence on a short-term basis. The non-laboratory-based tool, using ABSI as a predictor, may provide better predictive accuracy among women.
Highlights
Prediction of absolute risk of cardiovascular diseases (CVDs) has important clinical and public health significance, but the predictive ability of the available tools has not yet been tested in the rural Bangladeshi population
It is well-acknowledged that absolute risk assessment, based on the combined effect of multiple risk factors, yields better accuracy compared to the individual risk factor based approach in predicting CVD events [1, 2]
Absolute risk factor profiling was originally proposed in the landmark Framingham study [3, 4] and most of the later prediction tools [5,6,7] are adapted from the original one
Summary
Prediction of absolute risk of cardiovascular diseases (CVDs) has important clinical and public health significance, but the predictive ability of the available tools has not yet been tested in the rural Bangladeshi population. Prediction of risk can greatly help in the management and prevention of cardiovascular diseases (CVDs) as well as in designing long-term policies and programs in this sector It is well-acknowledged that absolute risk assessment, based on the combined effect of multiple risk factors, yields better accuracy compared to the individual risk factor based approach in predicting CVD events [1, 2]. Absolute risk factor profiling was originally proposed in the landmark Framingham study [3, 4] and most of the later prediction tools [5,6,7] are adapted from the original one Another important development in this area is the WHO/ISH 10-years CVD risk assessment chart proposed in 2007 [8] which was designed as a tool suitable for application in low resource settings. A number of studies have been conducted with the WHO/ISH tool in developing countries [12,13,14], but those are almost exclusively cross-sectional studies and validations by prospective and longitudinal studies are lacking
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