Comparative assessment of absolute cardiovascular disease risk characterization from non-laboratory-based risk assessment in South African populations

Autor: Gina Joubert, Thomas A. Gaziano, Dorcas Rosaley Prakaschandra, Naomi S. Levitt, Ankur Pandya, Corinna M. Walsh, Krisela Steyn, Aletta E. Schutte, Annamarie Kruger, Ria Laubscher, Datshana P Naidoo, Ayesha A. Motala, W F Mollentze
Přispěvatelé: 10062416 - Kruger, Annamarie, 10922180 - Schutte, Aletta Elisabeth, Department of Medicine, Faculty of Health Sciences
Jazyk: angličtina
Rok vydání: 2013
Předmět:
Zdroj: BMC Medicine
ISSN: 1741-7015
Popis: Background: All rigorous primary cardiovascular disease (CVD) prevention guidelines recommend absolute CVD risk scores to identify high- and low-risk patients, but laboratory testing can be impractical in low- and middle-income countries. The purpose of this study was to compare the ranking performance of a simple, non-laboratory-based risk score to laboratory-based scores in various South African populations. Methods: We calculated and compared 10-year CVD (or coronary heart disease (CHD)) risk for 14,772 adults from thirteen cross-sectional South African populations (data collected from 1987 to 2009). Risk characterization performance for the non-laboratory-based score was assessed by comparing rankings of risk with six laboratory-based scores (three versions of Framingham risk, SCORE for high- and low-risk countries, and CUORE) using Spearman rank correlation and percent of population equivalently characterized as ‘high’ or ‘low’ risk. Total 10-year non-laboratory-based risk of CVD death was also calculated for a representative cross-section from the 1998 South African Demographic Health Survey (DHS, n = 9,379) to estimate the national burden of CVD mortality risk. Results: Spearman correlation coefficients for the non-laboratory-based score with the laboratory-based scores ranged from 0.88 to 0.986. Using conventional thresholds for CVD risk (10% to 20% 10-year CVD risk), 90% to 92% of men and 94% to 97% of women were equivalently characterized as ‘high’ or ‘low’ risk using the non-laboratory-based and Framingham (2008) CVD risk score. These results were robust across the six risk scores evaluated and the thirteen cross-sectional datasets, with few exceptions (lower agreement between the non-laboratory-based and Framingham (1991) CHD risk scores). Approximately 18% of adults in the DHS population were characterized as ‘high CVD risk’ (10-year CVD death risk >20%) using the non-laboratory-based score. Conclusions: We found a high level of correlation between a simple, non-laboratory-based CVD risk score and commonly-used laboratory-based risk scores. The burden of CVD mortality risk was high for men and women in South Africa. The policy and clinical implications are that fast, low-cost screening tools can lead to similar risk assessment results compared to time- and resource-intensive approaches. Until setting-specific cohort studies can derive and validate country-specific risk scores, non-laboratory-based CVD risk assessment could be an effective and efficient primary CVD screening approach in South Africa. http://www.biomedcentral.com/1741-7015/11/170 http://www.biomedcentral.com/bmcmed/ http://dx.doi.org/10.1186/1741-7015-11-170
Databáze: OpenAIRE
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