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

Abstract

BackgroundAll 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.MethodsWe 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.ResultsSpearman 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.ConclusionsWe 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.

Increasing Prescription Length Could Cut Cardiovascular Disease Burden And Produce Savings In South Africa

“…24–26 The cardiovascular disease health states simulated in the model were coronary heart disease and stroke or cerebrovascular accident. Coronary heart disease states were further divided into myocardial infarction, angina, and resuscitated cardiac arrest.…”

Comparison of Nonblood-Based and Blood-Based Total CV Risk Scores in Global Populations

“…Following Gaziano et al [12], descriptions of the 5 risk scores, their underlying populations, inputs, and outputs are described in Table 1 [22e26]. Additional score calculation details, including the beta-coefficients, for each score are provided in the Online Appendix (Online Table 2).…”

“…For example, when comparing the risk scores, a 20% Fra-mingham CVD risk for fatal and nonfatal events is equiv-alent to a SCORE risk score of approximately 5% for fatal events only. Similar to analyses in a previous publication [12], the percentage agreement or concordance between Harvard NHANES score and each of the 4 laboratory-based scores was calculated by adding the proportions of in-dividuals who were equivalently characterized as "high" or "low" risk by both scores. We then determined percentage agreement between Harvard NHANES score and the other 4 laboratory-based risk scores by comparing their Spearman rank correlation coef ficients.…”

“…This previous work compared the ability to predict first-time fatal and nonfatal CVD events in the NHANES (National Health and Nutrition Examination Survey) I follow-up study cohort by 2 risk prediction models: the laboratory-based Framing-ham risk score and the Harvard NHANES non-laboratory-based model [11], which requires only history and physical examination measures and no measure of cholesterol. The exchangeability of the non-laboratory-based score with commonly used laboratory-based approaches has been validated in a U.S. population and assessed for agreement in South Africa [12,13], but not in other populations.…”

Cardiovascular Disease Screening By Community Health Workers Can Be Cost-Effective In Low-Resource Countries

“…14,15 The paper tool was subsequently converted into a mobile phone–based application. Compared to community health workers who used the paper tool, those who used the mobile application were trained in less time, took fifteen minutes less on average to conduct a screening, and had a lower error rate in cardiovascular disease risk assessment measurements.…”