Comparing six cardiovascular risk prediction models in Haiti: implications for identifying high-risk individuals for primary prevention.

Autor: Yan LD; Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA. liy9032@med.cornell.edu.; Center for Global Health, Weill Cornell Medicine, New York, NY, USA. liy9032@med.cornell.edu., Lookens Pierre J; Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti., Rouzier V; Center for Global Health, Weill Cornell Medicine, New York, NY, USA.; Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti., Théard M; Collège Haïtien de Cardiologie, Port-au-Prince, Haiti., Apollon A; Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti., St Preux S; Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti., Kingery JR; Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA.; Center for Global Health, Weill Cornell Medicine, New York, NY, USA., Jamerson KA; Division of Cardiovascular Disease, Department of Medicine, University of Michigan, Ann Arbor, MI, USA., Deschamps M; Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti., Pape JW; Center for Global Health, Weill Cornell Medicine, New York, NY, USA.; Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti., Safford MM; Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA., McNairy ML; Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA.; Center for Global Health, Weill Cornell Medicine, New York, NY, USA.
Jazyk: angličtina
Zdroj: BMC public health [BMC Public Health] 2022 Mar 19; Vol. 22 (1), pp. 549. Date of Electronic Publication: 2022 Mar 19.
DOI: 10.1186/s12889-022-12963-x
Abstrakt: Background: Cardiovascular diseases (CVD) are rapidly increasing in low-middle income countries (LMICs). Accurate risk assessment is essential to reduce premature CVD by targeting primary prevention and risk factor treatment among high-risk groups. Available CVD risk prediction models are built on predominantly Caucasian risk profiles from high-income country populations, and have not been evaluated in LMIC populations. We aimed to compare six existing models for predicted 10-year risk of CVD and identify high-risk groups for targeted prevention and treatment in Haiti.
Methods: We used cross-sectional data within the Haiti CVD Cohort Study, including 1345 adults ≥ 40 years without known history of CVD and with complete data. Six CVD risk prediction models were compared: pooled cohort equations (PCE), adjusted PCE with updated cohorts, Framingham CVD Lipids, Framingham CVD Body Mass Index (BMI), WHO Lipids, and WHO BMI. Risk factors were measured during clinical exams. Primary outcome was continuous and categorical predicted 10-year CVD risk. Secondary outcome was statin eligibility.
Results: Sixty percent were female, 66.8% lived on a daily income of ≤ 1 USD, 52.9% had hypertension, 14.9% had hypercholesterolemia, 7.8% had diabetes mellitus, 4.0% were current smokers, and 2.5% had HIV. Predicted 10-year CVD risk ranged from 3.6% in adjusted PCE (IQR 1.7-8.2) to 9.6% in Framingham-BMI (IQR 4.9-18.0), and Spearman rank correlation coefficients ranged from 0.86 to 0.98. The percent of the cohort categorized as high risk using model specific thresholds ranged from 1.8% using the WHO-BMI model to 41.4% in the PCE model (χ 2  = 1416, p value < 0.001). Statin eligibility also varied widely.
Conclusions: In the Haiti CVD Cohort, there was substantial variation in the proportion identified as high-risk and statin eligible using existing models, leading to very different treatment recommendations and public health implications depending on which prediction model is chosen. There is a need to design and validate CVD risk prediction tools for low-middle income countries that include locally relevant risk factors.
Trial Registration: clinicaltrials.gov NCT03892265 .
(© 2022. The Author(s).)
Databáze: MEDLINE
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