Risk Prediction Charts Research Articles

Cardiovascular risk factors in China: a nationwide population-based cohort study

It is estimated that 4 million deaths are due to cardiovascular diseases each year in China. Comprehensive understanding about modifiable risk factors and how the risk differs across regions is needed to inform public health policies. We aimed to examine the geographical profile of cardiovascular disease risk across China. In this study, we analysed data from a nationwide, population-based screening project, which covered 152 rural counties and 100 urban districts from 31 provinces in China. Between Sept 1, 2015, and Nov 30, 2019, standardised measurements were taken from participants aged 35-75 years who had lived in the region for at least 6 of the preceding 12 months to collect information on blood pressure, blood lipids, blood glucose, physical activity, tobacco smoking, alcohol use, overweight or obesity, and intake frequencies of fruits, vegetables, whole grains, legumes, and red meat. Individuals with a high risk of cardiovascular disease were identified according to medical history and WHO risk prediction charts. 983 476 individuals were included in this study. Among the participants included, 10·3% (95% CI 10·2-10·3) had a high cardiovascular disease risk after standardising age and sex, with a range of 3·1-24·9% across counties or districts. Among the seven regions in mainland China, the prevalence of high risk of cardiovascular disease was relatively high in northeast China (12·6% [12·4-12·8]) and north China (11·4% [11·3-11·6]), whereas it was low in south China (8·0% [7·8-8·2]). The geographical profiles of the 12 major cardiovascular disease risk factors were different. We found that the regions with high cardiovascular disease risk were facing challenges such as obesity and high blood pressure (north China) and consumption of unhealthy non-staple food (low intake of fruits and vegetables or high intake of red meat; northeast China). By contrast, south China-the region with the lowest cardiovascular disease risk-had the highest prevalence of unhealthy staple food (low intake of whole grains and beans), abnormal metabolism (glucose and lipid), and low physical activity in the country. Risk for cardiovascular diseases varies geographically, and the major contributing risk factors are different across regions in China. Hence, geographically targeted interventions are needed to mitigate the risk and reduce the burden in such a vast country. Ministry of Science and Technology, Ministry of Finance, and National Health Commission of China.

Cardiovascular Disease Risk Factors among Group C Employees in a Tertiary Health Care Centre in Puducherry: A Cross-sectional Study

International Journal of Medicine and Public Health,2020,10,4,147-151.DOI:10.5530/ijmedph.2020.4.32Published:November 2020Type:Original ArticleCardiovascular Disease Risk Factors among Group C Employees in a Tertiary Health Care Centre in Puducherry: A Cross-sectional StudySantosh Kumar, and Sitanshu Sekhar Kar Santosh Kumar1, Sitanshu Sekhar Kar2,* 1Master of Public Health, Department of Preventive and Social Medicine, JIPMER, Puducherry, INDIA. 2Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, INDIA. Abstract:Background: Settings based approach for health promotion at workplaces is surveillance of employees for CVD risk factors, which will help to estimate the prevalence of CVD risk factors and monitor CVD risks among the employees. It was planned to calculate the prevalence of CVD risk factors among group C employees of tertiary care hospital in south India. Materials and Methods: A hospital based cross-sectional survey was conducted among 324 group C employees aged ≥18 years as per the WHO “STEP wise approach to surveillance of non-communicable diseases” (STEPS) methodology. Standardized international protocols were used to measure behavioural risk characteristics (smoking, alcohol consumption, fruit and vegetable consumption, physical activity) and physical characteristics (weight, waist circumference, height and blood pressure). Multivariate analysis was done to know the factors, which carry independent risk of hypertension. Risk factor profiling of the employees was done using WHO/ISH risk prediction chart to estimate the 10 year risk of a fatal or nonfatal major cardiovascular events (myocardial infarction or stroke), according to age, gender, blood pressure, smoking status and presence or absence of self-reported status of diabetes mellitus. Data entry was done using Epi-data version 4.4.2.1. Data cleaning and analysis was done using Statistical Package of Social Sciences (SPSS) version 20. Results: Mean age in years was 34.3 (±8.26) and men contributed 79.3% of study participants. Prevalence of major cardiovascular risk factors was as follows: Current smokers 25.3% men, regular alcohol intake 29.01% between men, overweight (≥23 kg/m2) 26.4%, central obesity 16%, hypertension 13.7% and a past history of diabetes mellitus 15.6%. Almost 3/4th of the participants were following unhealthy diet and living sedentary life style. The relationship between sociodemographic factors and selected risk factors of CVD (tobacco use, alcohol use, unhealthy diet and physical activity) was found significant associated with gender, age, educational status and years of work experience. Around four percent participants had a >10% risk of developing CVD in next 10 years. Conclusion: The prevalence of CVD risk factors is high in the sample population. Employee health and wellness program must be regulated and implemented in the institute, to overcome the burden of cardiovascular diseases. Keywords:cardiovascular disease, Employee, Prevalence, Risk factor profile, Tertiary Health CareView:PDF (153.55 KB)

Geographical profiles of cardiovascular risk and the risk factors in China: data from a nationwide population-based screening project

Abstract Background In China, an abundance of cardiovascular risk factors has contributed to the increasing prevalence of cardiovascular diseases (CVD), which caused almost 4 million deaths per year. However, comprehensive evidence on the geographical profiles of cardiovascular disease risk in China is lacking, as findings in prior studies have been limited to relatively small sample sizes, had incomplete regional coverage, or focused on a narrow risk factor spectrum. Purpose To compare the population CVD risk among different regions across China, and to describe the geographical distributions of CVD risk factors and their clusters throughout the nation. Methods In a nationwide population-based screening project covering 252 counties of China, standardized measurements were conducted to collect information on 12 major CVD risk factors. Individuals of high CVD risk were identified as those with previous CVD, or with a predicted 10-year risk of CVD greater than 10% according to the WHO risk prediction charts. We applied factor analysis to generate “clusters” that characterized the clustering of these risk factors, then explored their relationship with the local ambient temperature and per capital GDP. Results Among 983476 participants included, 9.2% were of high CVD risk, with a range of 1.6% to 23.6% across counties. Among the seven regions in China, the rate was relatively high in the Northeast (11.8%) and North China (10.4%), while low in the South China (7.2%) and Northwest (7.8%). We identified 6 clusters underlying CVD risk factors, including Obesity factor, Blood pressure factor, Staple food factor, Non-staple food factor, Smoking and alcohol factor, and Metabolic and physical activity factor (Figure). We found high risk regions were facing different leading challenges, like obesity and blood pressure for the North China, while unhealthy non-staple food for the Northeast. The South China, as the region with the lowest CVD risk, still had the highest prevalence of unhealthy staple food. Lower annual average ambient temperature was associated with higher risk in Blood pressure factor, Obesity factor and Non-staple food factor, but lower risk in Staple food factor and Metabolic and physical activity factor (p<0.001 for all), consistently between rural and urban. Higher per capital GDP was associated with lower risk in Non-staple food factor in urban and higher risk in Metabolic and physical activity factor in rural (p<0.05 for both). The correlation between per capital GDP and Smoking and alcohol factor differed significantly between in rural and urban regions (p=0.042). Conclusions The geographical profile of CVD risk in China is complex - population risk levels varied substantially across regions, which were contributed by different risk factors. China needs geographically targeted intervention strategies considering environmental and socio-economic factors to control CVD risk and reduce the burden related to CVD. Geographical disparity of risk clusters Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): The National Key Research and Development Program from the Ministry of Science and Technology of China; the CAMS Innovation Fund for Medical Science

Identification of the high-risk patient in primary percutaneous coronary intervention: development and validation of a novel predictive index

Abstract Background Primary percutaneous coronary intervention (PPCI) is the best treatment for patients with ST elevation myocardial infarction (STEMI). Several risk scores have been created to help risk-stratify these patients but few of these can be calculated in-lab, during the acute event. Development of a score that could be applied during PPCI could aid operators' decisions regarding adjunctive therapies and post-procedural surveillance which could improve patient outcomes. This study aimed to develop a simple, practical risk model that could be applied during PPCI to identify high-risk patients. Methods Demographic, clinical and outcome data were collected for all patients, as part of the HEAT-PPCI trial, who underwent PPCI for suspected STEMI between February 2012 and November 2013 at our hospital. Independent predictors of the composite outcome of 28-day mortality or severe impairment of LV function (ejection fraction ≤35%) were identified using multiple logistic regression. A risk model was fitted and internal validation was performed by bootstrapping. External validation was performed on a separate cohort of patients with STEMI. Results The derivation cohort included 1271 patients, with 131/1271 = 10.3% experiencing the composite outcome of 28-day mortality or poor LV function. Three variables were required to predict the outcome: age (OR:2.07, 95% CI 1.55 to 2.78), location of the culprit artery (OR:6.16, 95% CI 4.00 to 9.47), myocardial blush grade post-PPCI (OR:2.32, 95% CI 1.39 to 3.88). External validation was performed on 324 patients undergoing PPCI from a different centre. The model showed good discrimination on ROC-curve analysis (c statistic 0.79, 95% CI 0.75 to 0.83) and performed well on external validation (c statistic 0.87, 95% CI 0.72 to 0.95). Accuracy of the risk model on the validation data was improved by simple recalibration. The model was used to create a risk prediction chart that can be used in-lab during PPCI (Figure 1). Conclusions We have developed a risk model that accurately predicts 28-day mortality or poor LV function following STEMI using age, culprit location and myocardial blush grade. The model can assist operators in identifying high-risk patients during PPCI. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): National Health Service, UK

Assessment of the Cardiovascular Risk of Persons with Hypertension and Diabetes Attending Clinics and Hypertension/Health Club Meetings in the AMIGA Municipalities of Cavite, Philippines using WHO/ISH Risk Prediction Charts

Objectives. This study aims to (1) determine the cardiovascular risk of persons with hypertension and diabetesattending hypertension/diabetic clinics or hypertension/health club meetings in the AMIGA (Alfonso, Mendez,Indang, General Emilio Aguinaldo and Amadeo) municipalities of Cavite; (2) suggest measures to improve thecardiovascular disease (CVD) program in these municipalities using the results of the study.
 Methods. A cross-sectional study was performed on patients diagnosed with hypertension and/or diabetes whoare attending clinics or club meetings in the barangays of the five AMIGA municipalities of Cavite. Participantswere interviewed using an abbreviated version of the World Health Organization (WHO) STEPS questionnaireon risk factors. The participants’ anthropometric measurements were obtained and their total blood cholesterollevels determined. CVD risk was then estimated using the WHO / International Society of Hypertension (ISH) riskprediction chart for the Western Pacific Region B.
 Results. 1,032 participants from 27 barangays qualified for the study. Participants were predominantly female(74%); over-all mean age was 58.43 years. Majority of the participants (79.17%) were found to be in the low-riskgroup; 11.34% were in the moderate risk group; 4.46% were in the high-risk group; while 5.05% were in the veryhigh-risk group. Majority of the participants were also found to be obese. Mean total cholesterol was 207.02 mg/dl.
 Conclusion. Majority of participants were stratified in the low-risk category (<10% chance to have cardiovascularevents in the next 10 years), while 9.5% were in the high-risk category (≥20% risk). Obesity is a major risk factorthat could be addressed in this population.

Estimation of total cardiovascular risk using the 2019 WHO CVD prediction charts and comparison of population-level costs based on alternative drug therapy guidelines: a population-based study of adults in Bangladesh

ObjectiveThe objective of this study was to estimate the population distribution of 10-year cardiovascular disease (CVD) risk among Bangladeshi adults aged 40 years and above, using the 2019 WHO CVD...

Assessment of Cardiovascular Disease Risk among Qatari Patients with Type 2 Diabetes Mellitus, Attending Primary Health Care Centers, 2014

Background: The accumulated knowledge on the development of cardiovascular disease in diabetic patients due to clustering and synergistic interaction of multiple risk factors leads to the establishment of cardiovascular disease 10-year risk prediction tools. The management of patients based on their total risk prediction is an effective way to reduce disease burden. The behavior of such tools varies based on population and their risk profile. Objective: To estimate the total 10-year cardiovascular disease risk using General Framingham Risk Prediction Score and World Health Organization /International Society for Hypertension (WHO/ISH) Risk Prediction Chart on Qatari diabetic patients. Methods: Cross-sectional design was used. A total of 532 Qatari diabetic patients attending primary healthcare were enrolled. Data were collected using an interview administered questionnaire, anthropometric & blood pressure measurement, and medical records. The total 10-year cardiovascular disease risk was assessed using the WHO/ISH risk prediction chart and Framingham score. Results: The former categorized (81.6%) of participants as low risk and only (3.8%) as in high and very high risk. While the later categorized (12.2%) of participants as low risk and (57.6%) as in high and very high risk. No agreement between both tools in assessment of cardiovascular disease risk (κ = - 0.019, p-value = 0.216). All risk factors used by both tools illustrated a statistically significant relation with risk categories, except ‘anti-hypertensive medications intake’ in the Framingham score. Conclusion: Encouraging assessment of patients based on total risk rather than single risk factor and further study of total risk prediction can help to establish a national tool for Qatar.

Estimation of cardiovascular diseases (CVD) risk using WHO/ISH risk prediction charts in tribal population of Chamarajanagar district, Karnataka

BackgroundIndia is the home to almost half the tribal population of the world and is second to Africa in terms of tribal mass. Because of acculturation many of these tribal have come out and relocated themselves outside the forest. As a result, life style has been changed which resulted in development of non-communicable diseases. In this context this study was carried out to estimate the prevalence CVD risk factors and to predict the cardiovascular events among tribal population, utilizing WHO/ISH risk prediction chart. MethodsCommunity based cross sectional study done for a period of 3 months. Information regarding socio demographic profile and risk factors were collected. Anthropometric measurements, Blood pressure, Random capillary Blood glucose were recorded. WHO/ISH risk prediction chart for SEAR D was used to assess the CVD risk in next 10 year. Data was analysed used SPSS version 25. Results were expressed as percentage and mean. Chi square test was used to find out the association. ResultsAmong 120 study population, 33.3% belongs to the age group of 40–49 years, 55% were females, 59.2% belongs to nuclear family, 39.2% were unskilled and 62.5% were uneducated. Prevalence of CVD risk factors among were as follows: Tobacco consumption (25.8%), alcohol (16.7%), diabetes (3.33%), hypertension (48.3%) and obesity (19.2%). 62.5% population had less than 10% (mild) risk and 11.7% had ≥40% (high) risk of developing. ConclusionAggressive screening is needed as many were unaware about theirs NCD status.

Association between knowledge and risk for cardiovascular disease among older adults: A cross-sectional study in China

ObjectivesThis study aimed to describe cardiovascular risk and cardiovascular disease (CVD) knowledge among older adults, and further explore the association between knowledge and risk. MethodsIn this cross-sectional study, we enrolled 1120 older adults who received physical examination in health centers. The participants were interviewed to obtain their behavioral risk factors related to CVD and clinical characteristics. A risk prediction chart was used to predict participants’ cardiovascular risk based on clinical characteristics and behavioral risk factors. Participants’ CVD knowledge was collected with a pretested knowledge questionnaire. ResultsAmong the 1120 participants, 240 (21.4%) had low cardiovascular risk, 353 (31.5%) had moderate cardiovascular risk, 527 (47%) had high and very high cardiovascular risk. The knowledge level about CVD among 0.8% of the 1120 participants was good while that of 56.9% was poor. Lower CVD knowledge level, older age, lower income, and lower educational level were the independent factors of higher cardiovascular risk level. ConclusionsThis study highlights the need to reduce the cardiovascular risk among older adults. CVD knowledge should be considered when developing health interventions.

A cross-sectional validation study comparing the accuracy of different risk scores in assessing the risk of acute coronary syndrome among patients in a tertiary care hospital in Kerala

BackgroundThere are many cardiovascular disease (CVD) risk score calculators in practice, which are not based on Indian population data. ObjectivesTo identify the best CVD risk score calculator applicable in the Indian population. Materials and methodsA total of 1000 patients presenting with acute coronary syndrome (ACS) were included in the study and their CVD risk score, had they presented before the event, was calculated. The Framingham risk score (FRS–body mass index [BMI], FRS–fasting lipid profile [FLP]), the American College of Cardiology/American Heart Association pooled cohort equation risk calculator (ACC/AHA PCE), Joint British Society risk calculator 3 (JBS3) and the World Health Organization (WHO) risk prediction charts (WHO TC and WHO without TC [WHO NO TC]) were used. ResultsIt was seen that among the 1000 people included in the study, the FRS-BMI (59.2%), FRS-FLP (61.5%), ACC/AHA (70.1%) and the JBS3 (62.5%) identified a majority as having a risk of ≥20%, whereas both the WHO TC (65.3%) and the WHO NO TC (64.5%) identified a majority of the ACS patients as having a risk of <20%. The sensitivity was highest for the ACC/AHA (87.8%), FRS-FLP (85.1%) and then JBS3 (80.1%), whereas the specificity was highest for the WHO TC (83.6%) and the WHO NO TC (82.1%). When looking at the accuracy, the FRS-FLP was the most accurate with 80.1%, whereas the ACC/AHA and the JBS3 followed at 74.7% and 73.1%, respectively. ConclusionThe ACC/AHA seems to be an acceptable risk prediction system to be used in the Indian population and is also relatively easy and cheap to use.

Predicting coronary heart disease using risk assessment charts and risk factor categories

Cardiovascular disease is the leading cause of death and disability in Egypt. An appropriate estimation of risk is important to improve cardiovascular outcomes and ensure efficient allocation of resources used to support disease prevention. Risk prediction charts have been developed to provide clinicians with a simple tool to estimate the absolute risk of developing coronary heart disease (CHD). To test the accuracy of the World Health Organization/International Society of Hypertension (WHO/ISH) risk prediction charts in predicting and identifying people at risk of developing CHD and to propose an alternative risk assessment instrument based on simple laboratory tests, routine examination, and reported personal and medical data. A cross-sectional screening survey was conducted at an emergency department of a health insurance hospital in Alexandria, Egypt. A total of 350 enrolled patients were evaluated clinically. We applied the WHO/ISH risk assessment chart for the Eastern Mediterranean region to test its accuracy in predicting CHD. The validation statistics indicated that the WHO/ISH risk prediction charts identified cases with CHD with 60.0% sensitivity and 93.2% specificity. At least nine risk factors for developing CHD were detected in all patients in the study cohort. Hypertension was the strongest predictor of CHD [odds ratio (OR) (95% confidence interval (CI)): 20.8 (5.6–76.9)]. Silent cardiovascular risk factors were ascertained in about 30% of the studied population, a finding that did not differ significantly by sex. We propose a different risk assessment model for general practice that incorporates standard cardiovascular risk factors, with or without laboratory tests. Standard cardiovascular risk factors included in a simple risk prediction algorithm can predict multivariate CHD risk in apparently healthy individuals. Non-laboratory-based risk assessment models have no superior advantage over those employing laboratory investigations.

Estimation of cardiovascular risk in a rural population of Lucknow district using WHO/ISH risk prediction charts.

Context:Cardiovascular diseases (CVDs) are the number one cause of death globally, with low- and middle-income countries being affected disproportionately. By 2020, it is projected that there will be 25 million deaths from CVD worldwide, 19 million of which would be from middle- and low-income countries.Aims:The aim of this study was to estimate the 10-year risk of cardiovascular events among adults aged ≥40 years in a rural population of Lucknow district using the World Health Organization (WHO)/International Society of Hypertension (ISH) risk prediction charts for SEAR-D region.Settings and Design:This was a community based cross-sectional study, conducted from September 2017 to August 2018, in the rural areas of Lucknow district.Methods and Material:This study was conducted on 397 subjects aged ≥40 years. The two sets of the WHO/ISH risk prediction charts, with and without cholesterol, for WHO SEAR-D region were used in the study.Statistical analysis used:SPSS, version 23 was used for data analysis.Results:Using the risk assessment tools, with and without cholesterol, 78.5 and 76.8%, respectively, of the study population were in the 10-year cardiovascular risk category of <10% risk, while 11.2 and 10.4%, respectively, were in the category of ≥20% risk. Risk categories were found to be concordant in 86.3% of the population.Conclusions:The WHO/ISH risk prediction charts can be used at low-cost resource setting as a tool to predict CVD risk among asymptomatic individuals, thus, helping in early detection and prevention of CVDs in resource-scarce settings.

Total cardiovascular risk assessment of women in delta state, Nigeria, using the world health Organization/International Society of Hypertension risk prediction chart

Background: Globally, women are not exempt from the menace of cardiovascular diseases. Methods: This cross-sectional study assessed the 10-year cardiovascular risk (CVR) for stroke or myocardial infarction of women aged ≥18 years attending opportunistic medical screening programs in two suburban communities in Delta State, Nigeria. Consenting women were consecutively recruited for the study, and the study instrument was the World Health Organization/International Society of Hypertension prediction chart for Africa (AFR D) without blood cholesterol. Total CVR was graded as low ( 40 years, 9.9% had never married, and 39.9% had a secondary level of education. The mean body mass index (29 vs. 27 kg/m2), systolic blood pressure (140 vs. 121 mmHg), diastolic blood pressure (87 vs. 77 mmHg), and blood glucose (104 vs. 92 mg/dl) were significantly higher among women aged ≥40 years. Smoking, hyperglycemia, and hypertension were noted in 0.0%, 7.0%, and 34.4% of the women, respectively. The 10-year risk of stroke or myocardial infarction was low in 87.7%, moderate in 7.2%, and high in 5.0% of the women. All the respondents with high CVR were aged ≥40 years. Among respondents aged

Estimating the Frequency of Risk Factors and the 10-Year Risk of Developing Cardiovascular Diseases in Middle-aged Population in Kerman, Iran

Background: Estimating the future risk of cardiovascular diseases (CVDs) and conducting primary prevention interventions in the high-risk groups are effective strategies. Objectives: This study was conducted to evaluate the prevalence of CVD risk factors and the results of CVD risk assessment in Kerman in 2017. Methods: A descriptive cross-sectional study was conducted among 450 middle-aged participants referring to health care centers using the multistage random sampling method. The risk prediction chart developed by the WHO and International Society of Hypertension was used for risk assessment. We used middle-aged population surveillance forms to extract the risk factors of CVDs. The prevalence of different risk factors was reported. Besides, we reported the CVD risk classifications and the prevalence of some risk factors. Results: The prevalence rates of hypertension, diabetes mellitus, and hyperlipidemia were 20.9%, 9.6%, and 8.6%, respectively. Moreover, 64.1% of the participants were overweight or obese. Abnormal waist circumference was observed in 57.5% of the participants. The prevalence of smoking was 12.9%. The prevalence rates of a sedentary lifestyle, inadequate fruit consumption, inadequate vegetable consumption, saturated fat consumption, and high-salt food consumption were 47.7%, 28.3%, 40.7%, 23.1%, and 25.3%, respectively. The prevalence rates of low, moderate, and high or very high risks of CVD were 90.3%, 5.3%, and 4.4%, respectively. Conclusions: There was a high prevalence of CVD risk factors in the middle-aged population. Policymakers should design effective interventions for modifying the main risk factors. Risk management is the main step to conduct strategies targeting high-risk groups.

Evaluating Cardiovascular Diseases Risk Utilizing WHO/ISH risk Prediction Charts among Urban Population in Mysuru, Karnataka

Background: “Demographic transition” has affected the health-care needs of the world’s population. The epidemiological transition from communicable diseases to Non-communicable diseases (NCDs) and Cardiovascular diseases(CVDs) being a leading cause of death calls for prevention of CVDs which will be the essential step to control the epidemic of NCDs. The aim of this study is to estimate the cardiovascular risk among adults aged ≥40 years, utilizing WHO/ISH risk charts. Method: A community based cross-sectional study conducted among 250 individuals aged ≥40 years residing in urban area ofMysuru, Karnataka. Study participantswere personally interviewed using a semistructured questionnaire. Information regarding anthropometric measurements and laboratory investigations were also collected. The 10-year risk for cardiovascular events was estimated using the WHO/ISH risk prediction charts. Results: Among 250 study participants, the mean age was 52.7 (+9.5) years and majority were females (69.6%). 25.6% had very high (≥40%) risk, 18% had 10-<20% risk, 23.2% had 20–<30% risk and 8% had 30–<40% estimated risk of developing fatal and non-fatal CVD event in next 10 years. The prevalence of risk factors like Hypertension, Diabetes, Hypercholesterolemia, Moderate Stress and Physical Inactivity were 49.2%, 28.8%, 24.4%, 45.6% and 8.8% respectively. Over-nutrition was more prevalent where 34.4% and 27.2% had class I obesity and class II obesity respectively. Conclusion: There was a high prevalence of CVD risk factors and estimated risk of CVD are significantly prevalent in the urban population. Simple tool like WHO/ISH risk prediction charts can be used as a screening tool to estimate the CVD risk occurrence in next 10 years, in a low resource country like India, even at a community level.

Development of an Efficient, Non-Invasive Method for Cardiovascular Disease Risk Stratification in a Resource-Limited Setting.

Augmentation Index (AIx) is considered as an important predictor of cardiovascular disease. So, quantification of AIx may provide a rapid cost-effective and non-invasive means of cardiovascular risk stratification. At present, WHO/ISH risk prediction charts are used to predict 10-year risk of a fatal or nonfatal major cardiovascular event, an assessment which requires laboratory support for blood chemistry and thus making it ill-suited for resource-limited settings. In this study, we examined the association of AIx with cardiovascular risk as determined by the WHO/ISH chart and identified AIx cut-offs to stratify patients into different risk categories. A case-control study with 162 cases and 61 controls was conducted in a tertiary care hospital in eastern India. Data were obtained for demographic, anthropometric, cardiovascular, and biochemical parameters. Cardiovascular risk assessment was carried out by WHO/ISH risk model in R. Statistical analysis was done for examining the association of AIx with WHO/ISH cardiovascular risk and for identifying AIx cut-offs to stratify patients into different risk categories. Box and whisker plots for assessing the correlation between AIx and WHO/ISH cardiovascular risk showed an increase in the median value of AIx with increasing risk in both cases and controls. Heart rate corrected AIx showed a steady increase with increasing risk in males. AIx cutoffs showed good sensitivity and specificity for each risk category. AIx is remarkably associated with cardiovascular risk as assessed by the WHO/ISH chart and the AIx cut-offs obtained in the study can be used as an efficient, non-invasive surrogate biomarker of cardiovascular risk even in resource-limited settings.

World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions

SummaryBackgroundTo help adapt cardiovascular disease risk prediction approaches to low-income and middle-income countries, WHO has convened an effort to develop, evaluate, and illustrate revised risk models. Here, we report the derivation, validation, and illustration of the revised WHO cardiovascular disease risk prediction charts that have been adapted to the circumstances of 21 global regions.MethodsIn this model revision initiative, we derived 10-year risk prediction models for fatal and non-fatal cardiovascular disease (ie, myocardial infarction and stroke) using individual participant data from the Emerging Risk Factors Collaboration. Models included information on age, smoking status, systolic blood pressure, history of diabetes, and total cholesterol. For derivation, we included participants aged 40–80 years without a known baseline history of cardiovascular disease, who were followed up until the first myocardial infarction, fatal coronary heart disease, or stroke event. We recalibrated models using age-specific and sex-specific incidences and risk factor values available from 21 global regions. For external validation, we analysed individual participant data from studies distinct from those used in model derivation. We illustrated models by analysing data on a further 123 743 individuals from surveys in 79 countries collected with the WHO STEPwise Approach to Surveillance.FindingsOur risk model derivation involved 376 177 individuals from 85 cohorts, and 19 333 incident cardiovascular events recorded during 10 years of follow-up. The derived risk prediction models discriminated well in external validation cohorts (19 cohorts, 1 096 061 individuals, 25 950 cardiovascular disease events), with Harrell's C indices ranging from 0·685 (95% CI 0·629–0·741) to 0·833 (0·783–0·882). For a given risk factor profile, we found substantial variation across global regions in the estimated 10-year predicted risk. For example, estimated cardiovascular disease risk for a 60-year-old male smoker without diabetes and with systolic blood pressure of 140 mm Hg and total cholesterol of 5 mmol/L ranged from 11% in Andean Latin America to 30% in central Asia. When applied to data from 79 countries (mostly low-income and middle-income countries), the proportion of individuals aged 40–64 years estimated to be at greater than 20% risk ranged from less than 1% in Uganda to more than 16% in Egypt.InterpretationWe have derived, calibrated, and validated new WHO risk prediction models to estimate cardiovascular disease risk in 21 Global Burden of Disease regions. The widespread use of these models could enhance the accuracy, practicability, and sustainability of efforts to reduce the burden of cardiovascular disease worldwide.FundingWorld Health Organization, British Heart Foundation (BHF), BHF Cambridge Centre for Research Excellence, UK Medical Research Council, and National Institute for Health Research.

Assessment of cardiovascular risk in a slum population in Kenya: use of World Health Organisation/International Society of Hypertension (WHO/ISH) risk prediction charts - secondary analyses of a household survey

ObjectivesAlthough cardiovascular disease (CVD) is of growing importance in low- and middle-income countries (LMICs), there are conflicting views regarding CVD as a major public health problem for the urban poor,...

Comparison of prevalence of life style risk factors and 10 year risk of CVD event among rural and tribal population of Kollegal Taluk, Chamrajanagar district, South India

ContextCardiovascular diseases have been recognized as leading cause of death. Three-fourths of CVD deaths occur in low and middle income countries. Surveillance of CVD risk factors is a key strategy for effective CVD prevention. Aims: To identify the extent of CVD risk factors and 10 year risk of developing Cardiovascular Disease events among rural and tribal population. Subjects and methods: This community based cross sectional study was conducted on a total of 482 rural and 415 tribal subjects aged above 30 years from Kollegal taluk, Chamrajanagar, Karnataka, India. Tobacco and alcohol consumption, BMI, blood pressure and capillary blood glucose were estimated. WHO/ISH risk prediction chart was used to predict 10 year risk of MI/stroke. ResultsTobacco consumption was 15.4% (rural) and 90.8% (tribal). Alcohol consumption was 10.8% (rural) and 21.9% (tribal), Obesity was 40.2% (rural) and 14.0% (tribal). Prevalence of Hypertension was 49.8% (rural) and 32.2% (Tribal) and diabetes 8.3% (rural) and 2.9% (tribal). Nearly one fourth of the population are at moderate risk (10–30%) and one tenth are at high risk (30%) of MI/Stroke within 10 years. ConclusionsHigh prevalence of tobacco consumption among tribal and high prevalence of hypertension and diabetes among rural predisposes 10% of population to moderate to high risk of stroke/MI within 10 years.

Evaluating the Adherence of Primary Health Care Centers in Gaza Strip to the WHO-PEN Protocol 1: A Cross-Sectional Study

Background: Cardiovascular disease (CVD) is common in the general population, affecting many of adults above 40 years of age. It is a multi-factorial disease. Some risk factors; such as family history, gender, ethnicity and age cannot be changed. Other risk factors are modifiable including high blood pressure, high cholesterol and diabetes. Patients will not necessarily develop cardiovascular disease if they have a risk factor. But the more risk factors they have the greater the likelihood that they will, unless protective measures and actions are taken to modify their risk factors and work to prevent them compromising their heart health. Objectives: The objectives of this study were: to evaluate the adherence of major primary health care centers to the WHO-PEN Protocol 1, Package of essential noncommunicable (PEN) disease interventions for primary health care, recommendations;and to provide more accurate estimate of cardiovascular risk using hypertension, type 2 diabetes mellitus and tobacco use as entry points. Methods: A cross-sectional study involving 200 patients who were already diagnosed with NCDs was conducted atprimary health care centers. Data was collected retrospectively using a self-designed questionnaire based on the WHO- PEN checklist. Patients’ files were selected randomly. Results: Based on the analysis of whole cohort (200 cases). The prevalence of type 2 diabetes was 39% and hypertension was 28.5%, whereas 32.5% had both. There were only 17 smokers among patients representing 8.5% of the sample. Using WHO/ISH, WHO/International Society of Hypertension, Risk prediction charts; half of patients were in the tenyear cardiovascular risk category of less than 10%. On the other hand, 5% had a ten-year cardiovascular risk over 40%.49% of patients had a first-degree family history of heart disease? All patients were counseled on diet, exercise and smoking cessation. Conclusion: These results demonstrate high adherence to the WHO-PEN protocol in these two centers reflecting a high quality of care and follow-up. Furthermore, the medical records were fully filled with adequate information for each item. However, there were some deficiencies in the risk estimation, which should be documented for better counseling for patients with high risk.