World Health Organization/International Society Of Hypertension Research Articles

Level of Cardiovascular Disease Risk and Associated Factors among Clients on Highly Active Antiretroviral Therapy in Vihiga County, Kenya

Context: HIV/AIDS is still a public health concern globally, especially in sub-Saharan Africa and Kenya. HIV-positive clients are initiated on highly active antiretroviral therapy (HAART) to reduce the multiplication of HIV and improve their immunity. These clients are at an increased cardiovascular disease risk due to a complex interplay of factors, including traditional cardiovascular risk factors such as smoking cigarettes, obesity due to inactivity, and diabetes. Aim: This study sought to determine the level of cardiovascular disease (CVD) risk factors among people living with HIV (PLHIV) on highly active antiretroviral therapy (HAART) in Vihiga County, Kenya. Methods: The study employed a cross-sectional survey design to report baseline survey data for an interventional study on the level of CVD risk factors. The study involved a systematic sample of 211 patients on HAART in six health facilities purposively selected from Vihiga County. Data was collected using the WHO STEPWISE questionnaire from six comprehensive care clinics in Vihiga County from March to July 2022. The World Health Organization-International Society of Hypertension (WHO-ISH) tool AFRI E CHART was used to estimate the cardiovascular risk. Results: The majority (96.68%) of PLWHIV on HAART in Vihiga county had low overall cardiovascular risk as predicted WHO/ISH score. Age (OR = 1.199, 95% CI [1.031, 1.394], p = 0.018) and smoking status (OR = 0.115, 95% CI [0.024, 0.558], p = 0.007) exhibited a significant association with the level of cardiovascular risk. Conclusion: The majority of PLHIV have a low estimated CVD risk. There is a need to prioritize weight management in HIV care, integrating healthy lifestyle behaviors and nutritional support while conducting regular cardiovascular risk assessments, focusing on modifiable factors like smoking. Age-specific interventions can also help mitigate the risk across the different age groups.

Risk estimation of cardiovascular diseases using the World Health Organization/International Society of Hypertension risk prediction charts in the Azar cohort population: Cross-sectional study.

Cardiovascular disease (CVD) is one of the most important health problems and the leading cause of mortality worldwide. This study aimed to estimate the risk of CVD using the World Health Organization/International Society of Hypertension (WHO/ISH) risk prediction charts. The demographic characteristics of all participants of this study aged 40-70 years who did not have a prior coronary event were collected. The 10-year CVD risk was estimated using the laboratory version of the WHO/ISH risk score charts. The risk scores for 11678 participants of the Azar cohort population were calculated. Participants were classified as low risk, moderate risk, or high risk. According to the WHO/ISH charts, only 0.1 % of the population was classified as high-risk (≥40%), and 96.8% had a 10-year CVD risk of<10%. Also, participants with overweight (P=0.002), obesity, and abdominal obesity had higher CVD risk(P<0.001). There was a low burden of 10-year CVD risk among the Azar cohort population without prior coronary events. It appears the percentage of people in the high-risk group is underestimated in the WHO/ISH risk prediction charts, leading to delays in receiving appropriate management in the population concerned. Therefore, using other charts alongside the WHO/ISH risk prediction charts is advisable.

Agreement between ten-years cardiovascular disease risk assessment tools: An application to Iranian population in Shahedieh Cohort Study

Background and aimCardiovascular risk-prediction models are efficient primary prevention tools to detect high-risk individuals. The study aims to use three tools to estimate the 10-year risk of developing cardiovascular disease (CVD) and investigate their agreement in an Iranian adult population. MethodsThe current cross-sectional study was carried out on 8569 adults between 35 and 70 who participated in the first phase of the Shahedieh cohort study in Yazd, Iran, and were free of CVDs (cardiac ischemia or myocardial infarction or stroke). World Health Organization/International Society of Hypertension (WHO/ISH) chart, Laboratory-Based (LB) and Non-Laboratory-Based (NLB) Framingham Risk Score (FRS) were used to predict the 10-year risk of developing CVD. The agreement across tools was determined by Kappa. ResultsWHO/ISH chart indicated the highest prevalence of low CVD risk for males (96.10%) and females (96.50%), while NLB Framingham had the highest prevalence of high CVD risk for males (19.40%) and females (5.30%). In total, there was substantial agreement between both FRS models (Kappa = o.70), while there was a slight agreement between WHO/ISH and both FRS tools. For under 60 years males and females, substantial agreements were observed between FRS methods (kappa = 0.73 and kappa = 0.68). For males and females over 60 years, this agreement was moderate and substantial, respectively (kappa = 0.54 and kappa = 0.64). WHO/ISH and LB Framingham model had substantial agreement for over 60 years females (kappa = 0.61). ConclusionsFramingham models classified more participants in the high-risk category than WHO/ISH. Due to the lethality of CVDs, categorizing individuals based on FRS can ensure that most of the real high-risk people are detected. Remarkable agreement between FRS methods in all sex-age groups suggested using the NLB Framingham model as a primary screening tool, especially in a shortage of resources condition.

Assessment of Total Cardiovascular Risk Using WHO/ISH Risk Prediction Chart Among Adults in Oman: A Nationally Representative Survey.

Cardiovascular diseases (CVDs) are the major cause of morbidity and mortality globally and in Oman. Stratifying the population under different risk levels based on the total CVD risk approach using the World Health Organization/International Society of Hypertension (WHO/ISH) risk prediction chart would be more effective in primary prevention of CVD to prioritize and utilize valuable resources. Hence, this study aimed to assess the total 10-year CVD risk among adults in Oman and to ascertain the proportion of the population in need of pharmacotherapy. We used the data from the 2017 national community-based STEPS survey conducted among men and women in Oman aged 40-80 years. Ten-year total cardiovascular risk was measured using the WHO/ISH risk prediction chart for Eastern Mediterranean Sub-Region B. Independent t-test and Chi-square were used to test significance. There were 2510 participants in the study. Their mean age was 51.5±10.1 years and 51.3% were male. The prevalence of low, moderate, and high CVD risk was 68.0%, 19.1%, and 12.9%, respectively, as benchmarked by the WHO/ISH chart. Immediate pharmacotherapy was needed by 30.3% of participants. Factors significantly associated with elevated CVD risk were the participant's age (p < 0.001), education level (p < 0.001), and employment status (p < 0.001). A substantial fraction of the population in Oman are at moderate or high CVD risk. Prompt pharmacological interventions are warranted for at least one in every five individuals in conjunction with lifestyle changes.

Cardiovascular risk factors and impending 10-year risk of fatal or non-fatal cardiovascular disease events among an urban population in Tamil Nadu state in South India - A community based cross-sectional study

Background: Coronary heart disease, peripheral arterial disease, cerebrovascular disease, congenital and rheumatic heart illnesses are among the heart and blood vessel disorders classified as cardiovascular diseases (CVDs). Sudden premature cardiovascular deaths among apparently healthy population can be well prevented by the early recognition of cardiovascular risk factors using validated cardiovascular risk prediction tools. Aims and Objectives: The World Health Organization/international society of hypertension (WHO/ISH) Risk Prediction Charts was utilized to estimate the upcoming 10-year risk of CVD events, and the study’s objectives were to identify the risk factors for high CVD risk among urban residents aged ≥40–79 years in Tamil Nadu State, South India. Materials and Methods: A total of 350 participants were selected for a community-based cross-sectional study using a two-stage selection technique. A pretested questionnaire, anthropometry and laboratory research were used to acquire the required data. Finding the relationship between the risk factors and high CVD risk among the subjects was done using both univariate and multivariate regression analysis. Results: Mean age of subjects was 55.6 years. Hypertensives and diabetics were 35.4% and 27.4%, respectively. An alarming 75.1% subjects were either overweight or obese. The WHO/ISH chart categorized 20.9% subjects with &gt;10% risk of impending CVDs. Risk factors which independently influenced high cardiovascular risk were “being unmarried” (adjusted odds ratio [aOR] 31.76; 95% CI; P=0.009), “positive family history” (aOR 4.13; P=0.017), “Sedentary Occupation” (aOR 3.18; P=0.036), and “alcohol usage” (aOR 3.03; 95% CI [1.06–10.27]; P=0.039). Conclusion: The study has identified that more than one-fifth of the subjects were under the &gt;10% CVD risk category thereby underscoring the immediate need for inclusion of CVD risk scoring tools in routine screening programs in all levels of health care settings as an effective health promotion strategy in curtailing the escalating incidence of CVDs events worldwide.

Cardiovascular disease risk profile and management among people 40 years of age and above in Bo, Sierra Leone: A cross-sectional study.

IntroductionAccess to care for cardiovascular disease risk factors (CVDRFs) in low- and middle-income countries is limited. We aimed to describe the need and access to care for people with CVDRF and the preparedness of the health system to treat these in Bo, Sierra Leone.MethodsData from a 2018 household survey conducted in Bo, Sierra Leone, was analysed. Demographic, anthropometric and clinical data on CVDRF (hypertension, diabetes mellitus or dyslipidaemia) from randomly sampled individuals 40 years of age and above were collected. Future risk of CVD was calculated using the World Health Organisation–International Society of Hypertension (WHO-ISH) calculator with high risk defined as >20% risk over 10 years. Requirement for treatment was based on WHO package of essential non-communicable (PEN) disease guidelines (which use a risk-based approach) or requiring treatment for individual CVDRF; whether participants were on treatment was used to determine whether care needs were met. Multivariable regression was used to test associations between individual characteristics and outcomes. Data from the most recent WHO Service Availability and Readiness Assessment (SARA) were used to create a score reflecting health system preparedness to treat CVDRF, and compared to that for HIV.Results2071 individual participants were included. Most participants (n = 1715 [94.0%]) had low CVD risk; 423 (20.6%) and 431 (52.3%) required treatment based upon WHO PEN guidelines or individual CVDRF, respectively. Sixty-eight (15.8%) had met-need for treatment determined by WHO guidelines, whilst 84 (19.3%) for individual CVDRF. Living in urban areas, having education, being older, single/widowed/divorced, or wealthy were independently associated with met need. Overall facility readiness scores for CVD/CVDRF care for all facilities in Bo district was 16.8%, compared to 41% for HIV.ConclusionThe number of people who require treatment for CVDRF in Sierra Leone is substantially lower based on WHO guidelines compared to CVDRF. CVDRF care needs are not met equitably, and facility readiness to provide care is low.

"Healthy Heart, Healthy You": Ten-Year Cardiovascular Disease (CVD) Risk among Adults in Anekal Taluk Hospital, Bangalore Urban District, Karnataka.

Cardiovascular Disease (CVD) is the leading cause of mortality globally. Over 75% of CVD deaths occur in low- and middle-income countries. To assess the 10-year CVD risk among adults aged 30 years and above attending the outpatient department at a Taluk Hospital, Bangalore Urban District, Karnataka. A cross-sectional study was conducted among 217 subjects above 30 years of age attending the hospital. They were selected by consecutive sampling and administered a face-validated interview schedule. WHO/ISH CVD risk assessment tool was used to categorize them into four categories of CVD risk. Additional risk factors like alcohol use and smoking were also assessed. The mean age of the subjects was 55.7 ± 12.3 years. About 65% of the study population had low risk (<10%), 21.2% had mild risk (10%-20%), 9.7% had moderate risk (20%-30%) and 4.1% had high risk (>30%) according to the World Health Organization/International Society of Hypertension (WHO/ISH) CVD risk assessment tool. In the study population, 4.6% were abusing alcohol as per the CAGE questionnaire. The burden of CVD risk among the adults interviewed was high. The WHO/ISH chart is an inexpensive tool that can be used for screening in a regular OPD.

A Ten-year Risk Assessment Study of Cardiovascular Events Among Adults Visiting a Tertiary Care Institution in Northern India

Introduction: Cardiovascular diseases (CVDs) are a group of disorders of the heart and blood vessels, including Myocardial Infarction (MI) and stroke. Risk factors included are both modifiable and non modifiable, like age, sex, blood pressure, smoking status, total blood cholesterol and presence or absence of diabetes mellitus. In the above background it is important to find out the risk of CVDs among patients visiting Urban Health Training Centre (UHTC) of a tertiary care institute. Early detection of risk probability will alert them to modify the involved risk factors to avert the CVDs. Aim: To find out the risk of CVDs among adult patients in a duration of ten years, who visited the Outpatient Department (OPD) of UHTC, using World Health Organisation/International Society of Hypertension (WHO/ISH) risk prediction Chart. Materials and Methods: A cross-sectional study was conducted in the Department of Community Medicine, of a tertiary care institution in Northern India, from August 2017 to January 2018. A total of 400 subjects were enrolled. Data were collected using the WHO/ISH ten years risk prediction chart. Chi-square test was applied and level of significance were obtained at p-value &lt;0.05. Results: Majority (58.75%) of the population belonged to the young adult age group (30-50 years). There were 216 males and 184 females. Overall, 7.75% people were diabetic, and 11.25% were smokers. Majority (69.5%) of the people had less than 10% risk for CVD, and 5.75% people had ≥40% risk. With respect to total serum cholesterol, 9% had high level of cholesterol. Statistically significant association was observed between Socio-economic Status (SES) (modified Kuppuswami scale) and cardiovascular event (p&lt;0.001). Middle income group were more at risk compared to others (p&lt;0.001). Conclusion: Middle income group people and young age group had more risk of developing CVDs in future, compared to low- income group and other age groups. So, an early intervention in the lifestyle may avoid CVDs. Also, this study gives way for further research on the weightage of the individual risk factors for CVDs.

Comparison of Cardiac Risk Scores among the East Mediterranean and South Asian Population.

Cardiovascular disease (CVD) is a global burden particularly in developing countries necessitates the periodical monitoring for these vulnerable population. This study aimed to compare four tools to measure the CVD risk between the East Mediterranean and South Asian population. This retrospective analysis included 139 patients from East Mediterranean (n=90) and South Asians (n=49) ethnicity who were admitted during the one-year period in a multi-specialty tertiary care hospital located in Tabuk, Saudi Arabia. Four different tools currently in use across the world were used to analyses the CVD risk. Atherosclerotic Cardiovascular Disease (ASCVD) from American College of Cardiology/American Heart Association (ACC/AHA) was found to be significant (P=0.0000) than World Health Organization/International Society of Hypertension (WHO/ISH) and Framingham Risk Score (FRS) European SCORE (Systematic Coronary Risk Evaluation) memo card from European Society of Cardiology risk prediction charts. Meanwhile, FRS looks equally good as it detects 44.89% of South Asian study population with >10% CVD risk while ACC/AHA detects 46.93%. The present study recommends ACC/AHA cardiac risk estimator to identify the CVD risk in East Mediterranean population. However, the South Asian population needed a population-based tool to assess the accurate CVD risk.

Dosimetric Predictors of Cardiac Events After Concurrent Chemoradiotherapy for Locally Advanced Esophageal Cancer

To investigate the predictive value of cardiac substructure dosimetric parameters for cardiotoxicity and overall survival (OS) in patients with esophageal cancer receiving concurrent chemoradiotherapy (CCRT).We retrospectively reviewed the records of 213 patients with thoracic esophageal cancer receiving CCRT from 2010 to 2016. The primary endpoint of this study was grade ≥ 3 cardiac events. Dose-volume histogram (DVH) parameters for whole heart (WH), left atrium (LA), left ventricle (LV), right atrium (RA), right ventricle (RV), left anterior descending (LAD), left circumflex (LCX), right coronary artery (RCA), and pericardium were extracted. Baseline cardiac status was assessed by noting whether patients had pre-existing cardiac disease. For those without pre-existing cardiac disease, the World Health Organization/International Society of Hypertension (WHO/ISH) risk score was calculated to assess patients' baseline cardiac risk. Competing risk analysis and Cox regressions analysis were performed.Median follow-up was 27 months. Forty-nine patients (23.0%) had pre-existing cardiac disease. Thirty-eight patients (17.8%) developed 42 grade ≥ 3 cardiac events, at a median of 12.5 months to first event. The most frequently observed cardiac events were acute coronary syndrome (ACS, n = 14), congestive heart failure (CHF, n = 10), and arrhythmia (n = 9). 89.5% of the first grade ≥ 3 events (n = 34) occurred within the first three years after CCRT. The best multivariable model based on lowest AIC (348.6) included the following covariates: pre-existing cardiac disease, age, and mean LCX dose. At 36, 60, and 100 months, the AUCs for this best model were 0.789, 0.762, and 0.849, respectively. For those without pre-existing cardiac disease (n = 164), variables incorporated in the optimal multivariable model (AIC = 155.4) were WHO/ISH 10-year risk and LV V20. At 36, 60, and 100 months, the AUCs for this optimal model were 0.682, 0.666, and 0.834, respectively. 10.3% developed one or more grade ≥ 3 ACS/CHF events. Under multivariate analysis, pre-existing cardiac disease and mean LCX dose were included in the optimal ACS/CHF events predicting model (AIC = 198.8). Pericardium V15 and LA V55 were significantly associated with pericardial and arrhythmic events, respectively. Grade ≥ 3 cardiac events and LA V45 were independent predictors for OS.Whether for all cardiac events or the specific ACS/CHF, pericardial, or arrhythmic events, the predictive performance of corresponding substructure doses outperformed the WH doses. Grade ≥ 3 cardiac events and higher LA dose were associated with worse OS.

Evaluation of cardiovascular risk in adult psychiatric outpatients in Qatar using two risk assessment tools.

Introduction: Individuals with serious mental illness (SMI) experience premature death, likely due to increased rates of obesity and cardiovascular disease (CVD). This study was conducted to estimate the CVD risk in a cohort of individuals with SMI receiving outpatient psychiatric services in Qatar and to assess contributory CVD risk factors.Methods: This is a retrospective review of the electronic medical records of a cohort of outpatients with SMI attending a mental health clinic in Doha, Qatar. The CVD risk was estimated using two risk prediction tools: the American Heart Association and the American College of Cardiology (AHA/ACC) risk calculator and the World Health Organization/International Society of Hypertension (WHO/ISH) CVD risk prediction charts for the Eastern Mediterranean region. Descriptive and inferential statistics were used to analyze the demographic and clinical data. Data were analyzed using Statistical Package for the Social Sciences.Results: Of the 346 eligible patients, 28% (n = 97) had obtainable data for the estimation of their CVD risk using both tools. Approximately one-third of the cohort (33%) were classified as high risk using the AHA/ACC risk calculator, and 13.3% were classified as intermediate to high risk using the WHO/ISH CVD risk prediction charts. Based on the AHA/ACC risk scores, among those with a high CVD risk, almost two-thirds had CVD modifiable risk factors (i.e., smoking, diabetes, dyslipidemia, and hypertension). No statistically significant difference in the CVD risk estimates was observed among individuals with a body mass index of more or lower than 30 kg/m2 (p = 0.815).Conclusion: Based on the AHA/ACC risk calculator, approximately one-third of the study cohort had high CVD risk estimates. The WHO/ISH CVD risk prediction charts appeared to underestimate CVD risk, particularly for those identified as high risk using the AHA/ACC risk calculator. A closer alliance between psychiatrists and primary healthcare professionals to control modifiable cardiovascular risk factors among patients with SMI is necessary.

Cardiovascular risk assessment among type-2 diabetic subjects in selected areas of Bangladesh: concordance among without cholesterol-based WHO/ISH, Globorisk, and Framingham risk prediction tools

IntroductionCardiovascular disease (CVD) risk is higher among the subjects with type-2 diabetes mellitus (T2DM) in low- and middle-income countries, like Bangladesh. However, there is no relevant available online published data for this country. We aimed at assessing the 10-year CVD risk among T2DM subjects in selected areas of Bangladesh using the without cholesterol-based joint World Health Organization/International Society of Hypertension (WHO/ISH), Globorisk, and Framingham Risk Score (FRS) risk prediction tools, and also evaluating the concordance among these tools. Methods and materialsIn this paper, we extracted a total of 327 subjects (40–60 years aged) from an observational study with 356 subjects, excluding those with diagnosed CVDs. The subjects were selected conveniently from purposively selected respective diabetic hospitals of Pirojpur and Dinajpur districts. We used the required respective variables of WHO/ISH, Globorisk, and FRS tools to predict CVD risks. The risks were categorized as low (<10%), moderate (10-<20%), high (20-<30%) and very high (≥30%). ResultsSubjects at moderate CVD risk were much higher identified by Globorisk (37.0%) and FRS (38.8%) compared to WHO/ISH (15.3%), and the same scenarios have also been observed for high (13.5%, 19.3% and 2.4%, respectively) and very high (5.5%, 17.4% and 1.8%, respectively) risks. There was fair level of concordance between WHO/ISH and Globorisk (PABAK-OS k = 0.37; 95% CI 0.33–0.42; P < 0.001), and Globorisk and FRS (PABAK-OS k = 0.34; 95% CI 0.30–0.39; P < 0.001). And, between WHO/ISH and FRS, it was none to slight level (PABAK-OS k = 0.09, 95% CI 0.04–0.14; P = 0.001). ConclusionsA significant proportion of the selected study subjects is at moderate to very high risk of developing CVDs predicted especially by Globorisk and FRS compared to WHO/ISH, indicating low concordance. With and without cholesterol-based studies can answer the problem more clearly.

Prevalence of and factors associated with hypertension according to JNC 7 and ACC/AHA 2017 guidelines in Bangladesh

Most studies either followed Joint National Committee 7 (JNC 7) or World Health Organization-International Society of Hypertension (WHO-ISH) guidelines to ascertain the prevalence of hypertension among Bangladeshi adults. The American College of Cardiology/American Heart Association (ACC/AHA) revised the definition of hypertension in 2017, which has significant public health importance. In Bangladesh, the new guideline has resulted changes in prevalence and risk factors for hypertension compared to the JNC7 guideline. This study used data from the most recent round (2017–2018) of the Bangladesh Demographic and Health Survey (BDHS). According to the 2017 ACC/AHA guideline, the participants were categorized as hypertensive if they had blood pressure (BP) ≥ 130/80 mmHg, but it was ≥ 140/90 mmHg in JNC 7 guideline. A total of 11,959 participants were involved in the analysis. The median (IQR) age of the respondents was 34.0 (18.0–95.0) years. The prevalence of hypertension was 24.0% according to the JNC 7 guideline, which was 50.5% according to the 2017 ACC/AHA guideline. Participants who were overweight and obese, aged, member of affluent households, Rangpur and Rajshahi division inhabitants had significantly higher odds of being hypertensive according to both guidelines. The new guideline suggests that half of the adult population in Bangladesh is hypertensive when measured according to the new guideline, urging the policymakers and public health practitioners to take immediate action to address the already established modifiable risk factors.

Validation of the World Health Organization/ International Society of Hypertension (WHO/ISH) cardiovascular risk predictions in Sri Lankans based on findings from a prospective cohort study.

Introduction and objectivesThere are no cardiovascular (CV) risk prediction models for Sri Lankans. Different risk prediction models not validated for Sri Lankans are being used to predict CV risk of Sri Lankans. We validated the WHO/ISH (SEAR-B) risk prediction charts prospectively in a population-based cohort of Sri Lankans.MethodWe selected 40–64 year-old participants from the Ragama Medical Officer of Health (MOH) area in 2007 by stratified random sampling and followed them up for 10 years. Ten-year risk predictions of a fatal/non-fatal cardiovascular event (CVE) in 2007 were calculated using WHO/ISH (SEAR-B) charts with and without cholesterol. The CVEs that occurred from 2007–2017 were ascertained. Risk predictions in 2007 were validated against observed CVEs in 2017.ResultsOf 2517 participants, the mean age was 53.7 year (SD: 6.7) and 1132 (45%) were males. Using WHO/ISH chart with cholesterol, the percentages of subjects with a 10-year CV risk <10%, 10–19%, 20%-29%, 30–39%, ≥40% were 80.7%, 9.9%, 3.8%, 2.5% and 3.1%, respectively. 142 non-fatal and 73 fatal CVEs were observed during follow-up. Among the cohort, 9.4% were predicted of having a CV risk ≥20% and 8.6% CVEs were observed in the risk category. CVEs were within the predictions of WHO/ISH charts with and without cholesterol in both high (≥20%) and low(<20%) risk males, but only in low(<20%) risk females. The predictions of WHO/ISH charts, with-and without-cholesterol were in agreement in 81% of subjects (ĸ = 0.429; p<0.001).ConclusionsWHO/ISH (SEAR B) risk prediction charts with-and without-cholesterol may be used in Sri Lanka. Risk charts are more predictive in males than in females and for lower-risk categories. The predictions when stratifying into 2 categories, low risk (<20%) and high risk (≥20%), are more appropriate in clinical practice.

Assessment of Cardiovascular Risk for Prevention and Control of Cardiovascular Disease in Ghana’s Northern Region A Cross-sectional Study of 4 Rural Districts using World Health Organization / International Society of Hypertension (WHO/ISH) Risk Prediction Charts

Ghana is experiencing an increase in cardiovascular (CVD) -related mortality with poor rural communities suffering greater complications and premature deaths. The point of this exploratory research is to evaluate the prevalence of CVD risk factors and to calculate the cardiovascular risk among adults aged &amp;gt; 40 years in Ghana&amp;rsquo;s Northern Region. A cross-sectional study was performed with 536 subjects. A pre-tested questionnaire, anthropometric measurements, and standardized WHO/ISH risk prediction charts assessed for 10-year risk of a fatal or non-fatal major cardiovascular event according to age, sex, blood pressure, smoking status, and diabetes mellitus status. Low, moderate and high CVD prevalence risk in females was 88.4%, 7.1%, and 4.5% while in males the prevalence was 91.3%, 5.8%, and 2.9%, respectively. Hypertension was noted as a clinically significant risk factor with females at 37.3% versus males at 32%. The 10-year risk of a fatal or non-fatal cardiovascular event was statistically significant for females according to age group. A moderate to high CVD risk of a fatal or non-fatal cardiovascular event was found in 10.4% of subjects. Notable CVD risk factors included a high prevalence of hypertension. Decentralizing care to local village healthcare facilities is one way to tackle cardiovascular risk reduction. Task shifting of primary care duties from physicians to nurses in terms of cardiovascular (CV) risk assessment and management of uncomplicated CV risk factors is a potential solution to the acute shortage of trained health staffs for the control and prevention of CVD in Northern Ghana.

Assessment of ten-year risk of cardiovascular event using WHO/ISH risk prediction chart among adults in a tertiary care hospital in Puducherry, India

Context: The changing trends have revealed that cardiovascular disease (CVD) has evolved as prime cause of mortality globally, and predicting this prior is of utmost interest in patient management. Objective: To assess the ten-year risk of fatal or non-fatal cardiovascular event using World Health Organization/ International Society of Hypertension (WHO/ISH) risk prediction chart among adults. Material and methods: A cross sectional study was conducted among 226 general medicine Outpatient Department (OPD) attendees of a tertiary care hospital. Their risk of encountering a major cardiovascular event such as myocardial infarction or stroke ten year later was assessed using the WHO/ISH risk prediction charts. Appropriate tests of significance were employed. Results: Among 226 study subjects, 174 (76.9%) at low risk, 36 (15.9%) at moderate risk and 16 (7.0%) were at high risk of developing major cardiovascular event in the next ten years. Risk factors such age above 50 years, male gender, presence of hypertension or diabetes and smoking were found to be significantly associated with increased risk of the predicted major cardiovascular event. Conclusions: WHO/ISH chart is a useful tool in identifying individuals at high-risk of cardiovascular disease (CVD) and could help in planning appropriate strategies to mitigate the estimated CVD burden in future.

Place of cardiovascular risk prediction models in South Asians; agreement between Framingham risk score and WHO/ISH risk charts

There are no cardiovascular risk prediction models developed in South Asian cohorts. Therefore, different risk models not validated in South Asians are being used. We aimed to compare cardiovascular risk predictions of Framingham risk score (FRS) and World Health Organization/International Society of Hypertension (WHO/ISH) charts for agreement in a sample of South Asians. Ten-year cardiovascular risk predictions of patients without previous cardiovascular diseases attending a non-communicable disease clinic were calculated using FRS (with BMI and with cholesterol) and WHO/ISH charts (with and without cholesterol). Patients were categorised into low (<20%) and high (≥20%) cardiovascular risk groups on risk predictions. Agreement in risk categorisation with different prediction models was compared using Cohen's kappa coefficient (κ). One hundred sixty-nine patients (females 130 (81.1%)) mean age 65±6.9years were studied. Of the participants, 80 (47.3%), 62 (36.7%), 18 (10.7%), 16 (9.5%), were predicted high risk by FRS BMI-based, FRS cholesterol-based, WHO/ISH without-cholesterol and WHO/ISH with-cholesterol models, respectively. Agreement between the two FRS models (κ=0.736, P<.0001) and the two WHO/ISH models (κ=0.804, P<.0001) in stratifying patients into high and low-risk groups, was "good." However, the agreements between FRS BMI-based and WHO/ISH without-cholesterol models (κ=0.234, P<.0001) and FRS cholesterol-based and WHO/ISH with-cholesterol models (κ=0.306, P<.0001) were only "fair." Cardiovascular risk predictions of FRS were higher than WHO/ISH charts and the agreement in risk stratification was not satisfactory in Sri Lankans. Therefore, different cardiovascular risk prediction models should not be used interchangeably in the follow-up of South Asians.

Estimation of the 10-Year Risk of Cardiovascular Diseases: Using the SCORE, WHO/ISH, and Framingham Models in the Shahrekord Cohort Study in Southwestern Iran.

Background: Predicting the risk of cardiovascular diseases (CVDs) helps the management of high-risk individuals by the health system. We sought to determine the 10-year risk of CVDs in the Shahrekord Cohort Study (SCS). Methods: In this cross-sectional study based on the SCS in the southwest of Iran, the demographic, anthropometric, clinical, and laboratory data of 5152 persons recruited in the SCS by census method from 2016 to 2017 were used. R software was utilized to calculate the 10-year risk of CVDs according to the World Health Organization/International Society of Hypertension (WHO/ISH) chart, the Framingham Risk Score (FRS) model, and the Systematic Coronary Risk Evaluation (SCORE) model. Results: The mean age of the participants was 49.49±9.40 years, and 50.3% of them were female. According to the WHO/ISH chart, 94.1% of the participants were in the low-risk class, 4.1% in the moderate-risk class, and 0.4% in the high-risk class. Based on the FRS model, 72.2% of the participants were in the low-risk class, 18% in the middle-risk class, and 9.8% in the high-risk class. On the basis of the SCORE model for low-risk areas, 55.3% of the participants were in the low-risk class, 39.6% in the moderate-risk class, and 5.1% in the high-risk class. The agreement concerning risk estimation between the models was approximately 70%. Conclusion: The risk estimated in this study was higher than that in other similar studies. For monitoring risk trends over time, it is essential to nativize a valid risk function, including ethnicity and geographical characteristics, for the Iranian population.

ADHERENCE TO ESSENTIAL HYPERTENSION TREATMENT GUIDELINES IN A TERTIARY HOSPITAL IN NIGERIA

Objective: This study determined the level of prescribers’ adherence to the World Health Organization/International Society of Hypertension (WHO/ISH) guidelines for the management of hypertension at the Lagos University Teaching Hospital (LUTH), Nigeria.&#x0D; Methods: This study employed a retrospective cross-sectional design. Two groups were used: Group A (300 patients) were treated before the guidelines review in 2003, while Group B (200 patients) were treated after. The two study groups were compared, and systolic blood pressure of 130 mm Hg or above was taken as the index of hypertension.&#x0D; Results: There were 198 (66%) male patients in Group A, while Group B had 136 (68%) males. The highest age for Group A was 50–59 y for 89 (30%) patients, unlike group B that had 58 (29%) patients in aged 40–49 y as the highest. The highest blood pressure range for patients in Group A was 150–159 mm Hg for 64 (21%) patients, unlike Group B that had 43 (22%) patients as the highest in the same range. Furosemide was present in 282 (24%) prescriptions for group A patients. However, atenolol was present in 61 (20%) prescriptions for the same group. In group B, Furosemide was prescribed in 197 (97%) encounters, while Nifedipine was found in 81(40%) prescriptions.&#x0D; Conclusion: Prescribers at LUTH complied substantially with WHO/ISH guidelines in the management of hypertension. Diuretics and beta-blockers were used before the guideline review. After the review, diuretics and calcium channel blockers were the most frequently prescribed antihypertensives.

Risk Evaluation of Cardiovascular Diseases among Nurses Aged more than 40 Years: Report from a Tertiary Care Center in North India

Background: The nurses are in the frontline of health services in any country and their contribution to healthcare is immense. Nurses undergo moderate to a high level of stress and burn out due to their hectic work schedule, shift duties, workload and sleep deficit. Hence, nurses are at risk of being the victims of various risk factors of Cardiovascular Disease (CVD). Objectives: To investigate the risk factors of cardiovascular disease and risk prediction of CVD in the next ten years among nurses aged more than 40 years working in a tertiary care center, North India. Methods: Using a convenient sampling technique, a crosssectional study was conducted among 154 Nursing Officers working in a tertiary care center, North India. The nurses were enrolled after obtaining informed written consent. Ethical permission was taken from the Institute Ethics Committee. World Health Organisation/ International Society of Hypertension (WHO/ISH) prediction chart was used to predict the 10-year risk of a CVD. Results: The prevalent risk factors of CVD seen in nurses were obesity, high waist-hip ratio, stress, and abnormal lipid profile. The risk of developing CVD in the next ten years was less than 10% in 83% of nurses. More than 40% risk of developing CVD in the next ten years was found only in 3%, and risk between 10 and 30% was found in approximately 14% of the nurses. It was found that a significantly higher number of nurses who had a higher risk of developing CVD in the next ten years had abnormally lower High-Density Lipoprotein (HDL) cholesterol, higher Low-Density Lipoprotein (LDL) cholesterol levels and high triglyceride levels. Conclusion: The prevalent risk factors of CVD identified among nurses were obesity, increased waist-hip ratio, and abnormal lipid profile. High risk of developing CVD among nurses in the next ten years was found to be low. But, considering the moderate risk of developing CVD and high prevalence of risk factors, nurses need to take passable measures to control their risk factors targeting for long-term prevention of CVD.