The clinical performance of an office-based risk scoring system for fatal cardiovascular diseases in North-East of Iran.

Sadaf G Sepanlou,Maryam Sharafkhah,Paolo Boffetta,Farin Kamangar,Sanford M Dawsey,Christian C Abnet,Saeed Ghodsi,Fatemeh Malekzadeh,Arash Etemadi,Reza Malekzadeh,Akram Pourshams,Paul Brennan,Hossein Poustchi,Paul D Pharoah,Flávio Danni Fuchs

doi:10.1371/journal.pone.0126779

Abstract

BackgroundCardiovascular diseases (CVD) are becoming major causes of death in developing countries. Risk scoring systems for CVD are needed to prioritize allocation of limited resources. Most of these risk score algorithms have been based on a long array of risk factors including blood markers of lipids. However, risk scoring systems that solely use office-based data, not including laboratory markers, may be advantageous. In the current analysis, we validated the office-based Framingham risk scoring system in Iran.MethodsThe study used data from the Golestan Cohort in North-East of Iran. The following risk factors were used in the development of the risk scoring method: sex, age, body mass index, systolic blood pressure, hypertension treatment, current smoking, and diabetes. Cardiovascular risk functions for prediction of 10-year risk of fatal CVDs were developed.ResultsA total of 46,674 participants free of CVD at baseline were included. Predictive value of estimated risks was examined. The resulting Area Under the ROC Curve (AUC) was 0.774 (95% CI: 0.762-0.787) in all participants, 0.772 (95% CI: 0.753-0.791) in women, and 0.763 (95% CI: 0.747-0.779) in men. AUC was higher in urban areas (0.790, 95% CI: 0.766-0.815). The predicted and observed risks of fatal CVD were similar in women. However, in men, predicted probabilities were higher than observed.ConclusionThe AUC in the current study is comparable to results of previous studies while lipid profile was replaced by body mass index to develop an office-based scoring system. This scoring algorithm is capable of discriminating individuals at high risk versus low risk of fatal CVD.

Highlights

The incidence and overall burden of non-communicable diseases is increasing across the globe [1], and more so in developing countries
The following risk factors were used in the development of the risk scoring method: sex, age, body mass index, systolic blood pressure, hypertension treatment, current smoking, and diabetes
The resulting Area Under the ROC Curve (AUC) was 0.774 in all participants, 0.772 in women, and 0.763 in men

Summary

Introduction

The incidence and overall burden of non-communicable diseases is increasing across the globe [1], and more so in developing countries. In developing countries, where there are limited resources, prioritizing the allocation of resources based on risk of disease is important. Such risk stratification is possible using a combination of well-established risk factors, such as age, sex, high blood pressure, smoking, dyslipidemia, and diabetes. To provide the best estimate of risk, it is important to use a combination of these risk factors in a model, to avoid over-treatment or under-treatment [5]. Risk scoring systems for CVD are needed to prioritize allocation of limited resources. Most of these risk score algorithms have been based on a long array of risk factors including blood markers of lipids. We validated the office-based Framingham risk scoring system in Iran

Objectives

Methods

Conclusion