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Laboratory-based and office-based risk scores and charts to predict 10-year risk of cardiovascular disease in 182 countries: a pooled analysis of prospective cohorts and health surveys
P. Ueda, M. Woodward, Y. Lu, K. Hajifathalian, R. Al-Wotayan, CA. Aguilar-Salinas, A. Ahmadvand, F. Azizi, J. Bentham, R. Cifkova, M. Di Cesare, L. Eriksen, F. Farzadfar, TS. Ferguson, N. Ikeda, D. Khalili, YH. Khang, V. Lanska, L. León-Muñoz,...
Language English Country England, Great Britain
Document type Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't
- MeSH
- Global Health MeSH
- Adult MeSH
- Risk Assessment methods MeSH
- Cardiovascular Diseases diagnosis epidemiology MeSH
- Middle Aged MeSH
- Humans MeSH
- Prospective Studies MeSH
- Risk Factors MeSH
- Aged MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Research Support, N.I.H., Extramural MeSH
BACKGROUND: Worldwide implementation of risk-based cardiovascular disease (CVD) prevention requires risk prediction tools that are contemporarily recalibrated for the target country and can be used where laboratory measurements are unavailable. We present two cardiovascular risk scores, with and without laboratory-based measurements, and the corresponding risk charts for 182 countries to predict 10-year risk of fatal and non-fatal CVD in adults aged 40-74 years. METHODS: Based on our previous laboratory-based prediction model (Globorisk), we used data from eight prospective studies to estimate coefficients of the risk equations using proportional hazard regressions. The laboratory-based risk score included age, sex, smoking, blood pressure, diabetes, and total cholesterol; in the non-laboratory (office-based) risk score, we replaced diabetes and total cholesterol with BMI. We recalibrated risk scores for each sex and age group in each country using country-specific mean risk factor levels and CVD rates. We used recalibrated risk scores and data from national surveys (using data from adults aged 40-64 years) to estimate the proportion of the population at different levels of CVD risk for ten countries from different world regions as examples of the information the risk scores provide; we applied a risk threshold for high risk of at least 10% for high-income countries (HICs) and at least 20% for low-income and middle-income countries (LMICs) on the basis of national and international guidelines for CVD prevention. We estimated the proportion of men and women who were similarly categorised as high risk or low risk by the two risk scores. FINDINGS: Predicted risks for the same risk factor profile were generally lower in HICs than in LMICs, with the highest risks in countries in central and southeast Asia and eastern Europe, including China and Russia. In HICs, the proportion of people aged 40-64 years at high risk of CVD ranged from 1% for South Korean women to 42% for Czech men (using a ≥10% risk threshold), and in low-income countries ranged from 2% in Uganda (men and women) to 13% in Iranian men (using a ≥20% risk threshold). More than 80% of adults were similarly classified as low or high risk by the laboratory-based and office-based risk scores. However, the office-based model substantially underestimated the risk among patients with diabetes. INTERPRETATION: Our risk charts provide risk assessment tools that are recalibrated for each country and make the estimation of CVD risk possible without using laboratory-based measurements. FUNDING: National Institutes of Health.
Baker IDI Heart and Diabetes Institute Melbourne VIC Australia
Central Department of Primary Health Care Ministry of Health Kuwait City Kuwait
Centro de Investigación en Salud Poblacional Instituto Nacional de Salud Publica Cuernavaca Mexico
Department of Epidemiology Harvard School of Public Health Boston MA USA
Department of Epidemiology Johns Hopkins University Baltimore MD USA
Department of Global Health and Population Harvard School of Public Health Boston MA USA
Department of Information Evidence and Research WHO Geneva Switzerland
Department of Internal Medicine Cleveland Clinic Cleveland OH USA
Department of Natural Sciences School of Science and Technology Middlsex University London UK
División Salud Pública y Medicina Familiar Pontificia Universidad Católica de Chile Santiago Chile
MRC PHE Centre for Environment and Health Imperial College London London UK
National Institute of Public Health University of Southern Denmark Copenhagen Denmark
Non communicable Diseases Prevention and Control Program at the Ministry of Health Kampala Uganda
Statistical Unit Institute for Clinical and Experimental Medicine Prague Czech Republic
The George Institute for Global Health University of Oxford Oxford UK
The George Institute for Global Health University of Sydney Sydney NSW Australia
University of Health Sciences Phnom Penh Cambodia
Wellcome Trust Centre for Global Health Research London UK
WHO Collaborating Centre on NCD Surveillance and Epidemiology Imperial College London London UK
WHO Malawi Country Office Lilongwe Malawi
Yale Yale New Haven Hospital Center for Outcomes Research and Evaluation New Haven CT USA
References provided by Crossref.org
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- $a BACKGROUND: Worldwide implementation of risk-based cardiovascular disease (CVD) prevention requires risk prediction tools that are contemporarily recalibrated for the target country and can be used where laboratory measurements are unavailable. We present two cardiovascular risk scores, with and without laboratory-based measurements, and the corresponding risk charts for 182 countries to predict 10-year risk of fatal and non-fatal CVD in adults aged 40-74 years. METHODS: Based on our previous laboratory-based prediction model (Globorisk), we used data from eight prospective studies to estimate coefficients of the risk equations using proportional hazard regressions. The laboratory-based risk score included age, sex, smoking, blood pressure, diabetes, and total cholesterol; in the non-laboratory (office-based) risk score, we replaced diabetes and total cholesterol with BMI. We recalibrated risk scores for each sex and age group in each country using country-specific mean risk factor levels and CVD rates. We used recalibrated risk scores and data from national surveys (using data from adults aged 40-64 years) to estimate the proportion of the population at different levels of CVD risk for ten countries from different world regions as examples of the information the risk scores provide; we applied a risk threshold for high risk of at least 10% for high-income countries (HICs) and at least 20% for low-income and middle-income countries (LMICs) on the basis of national and international guidelines for CVD prevention. We estimated the proportion of men and women who were similarly categorised as high risk or low risk by the two risk scores. FINDINGS: Predicted risks for the same risk factor profile were generally lower in HICs than in LMICs, with the highest risks in countries in central and southeast Asia and eastern Europe, including China and Russia. In HICs, the proportion of people aged 40-64 years at high risk of CVD ranged from 1% for South Korean women to 42% for Czech men (using a ≥10% risk threshold), and in low-income countries ranged from 2% in Uganda (men and women) to 13% in Iranian men (using a ≥20% risk threshold). More than 80% of adults were similarly classified as low or high risk by the laboratory-based and office-based risk scores. However, the office-based model substantially underestimated the risk among patients with diabetes. INTERPRETATION: Our risk charts provide risk assessment tools that are recalibrated for each country and make the estimation of CVD risk possible without using laboratory-based measurements. FUNDING: National Institutes of Health.
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