Comparison of Laboratory and Non-Laboratory-Based 2019 World Health Organization Cardiovascular Risk Charts in the Bhutanese Population

Abstract

The World Health Organization (WHO) recommends the use of color-coded cardiovascular disease (CVD) risk charts for CVD management. This study evaluated the agreement between the laboratory and non-laboratory 10-year CVD risks based on 2019 WHO CVD risk-prediction charts. The agreement of CVD risk scores among 40- to 69-year-old Bhutanese population stratified by gender and age groups (<60 and ≥60 years) was determined via weighted kappa statistics. In the general population, there was substantial agreement between the two CVD risk score charts for all ages and <60 years but a moderate agreement for participants aged ≥60 years. In males, substantial agreement was observed in all ages and in <60 years and moderate agreement in ≥60 years. In females, both the predictions showed substantial agreement in all ages and <60, but a moderate agreement for ≥60 years. The non-laboratory-based risk charts can be used interchangeably with laboratory-based charts for predicting 10-year CVD risk in resource-constrained countries like Bhutan.

Assessment of ten-year cardiovascular disease risk in Bangladesh: A comparative analysis of laboratory and non-laboratory-based WHO risk prediction models

“…(non-laboratory-based) in Eastern Sub-Saharan Africa. [23], [24] Over three-fifths of the population were categorized as very low risk (<5%), and about one-fifth as low risk (5%-<10%), with similar patterns in both models. Although the likelihood of cardiovascular events is generally lower in people with lower risk, it is crucial to understand that they are not entirely risk-free.…”

“…These observations support existing literature that validates non-laboratory methods as reliable alternatives for CVD risk assessment, making them particularly beneficial in resource-constrained environments. [23], [36] The Lin's Concordance Correlation Coefficient (LCCC) values demonstrated substantial agreement (overall LCCC = 0.90), with slightly higher concordance in males. These findings confirm the consistency of both assessment methods in evaluating CVD risk, supporting their use across various clinical and epidemiological settings.…”

“…Similarly, studies conducted in North India reported lower Kappa values, whereas those in Bhutan noted higher values. [23], [37] This agreement is key for public health strategies, aiding high-risk population identification and intervention. Nonlaboratory methods are beneficial for their simplicity and low resource needs.…”