Risk scoring for the primary prevention of cardiovascular disease

Karmali, Kunal N.; Persell, Stephen D.; Perel, Pablo; Lloyd‐Jones, Donald M.; Berendsen, Mark; Huffman, Mark D.

doi:10.1002/14651858.cd006887.pub4

Cited by 102 publications

(104 citation statements)

References 166 publications

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“…4,5 Risk prediction models can be a component of cardiovascular disease prevention and control efforts, because they can help to identify people at high risk of cardiovascular disease who should benefit the most from preventive interventions. 6,7 Many such risk prediction models have been developed, [8][9][10][11][12][13] usually estimating individual risk over a 10-year period by use of measured levels of conventional risk factors for cardiovascular disease. 14 However, available models have limitations for use in low-income and middle-income countries.…”

Section: Introductionmentioning

confidence: 99%

World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions

Kaptoge¹,

Pennells²,

Bacquer³

et al. 2019

The Lancet Global Health

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626

459

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Background To help adapt cardiovascular disease risk prediction approaches to low-income and middle-income countries, WHO has convened an effort to develop, evaluate, and illustrate revised risk models. Here, we report the derivation, validation, and illustration of the revised WHO cardiovascular disease risk prediction charts that have been adapted to the circumstances of 21 global regions. Methods In this model revision initiative, we derived 10-year risk prediction models for fatal and non-fatal cardiovascular disease (ie, myocardial infarction and stroke) using individual participant data from the Emerging Risk Factors Collaboration. Models included information on age, smoking status, systolic blood pressure, history of diabetes, and total cholesterol. For derivation, we included participants aged 40-80 years without a known baseline history of cardiovascular disease, who were followed up until the first myocardial infarction, fatal coronary heart disease, or stroke event. We recalibrated models using age-specific and sex-specific incidences and risk factor values available from 21 global regions. For external validation, we analysed individual participant data from studies distinct from those used in model derivation. We illustrated models by analysing data on a further 123 743 individuals from surveys in 79 countries collected with the WHO STEPwise Approach to Surveillance. Findings Our risk model derivation involved 376 177 individuals from 85 cohorts, and 19 333 incident cardiovascular events recorded during 10 years of follow-up. The derived risk prediction models discriminated well in external validation cohorts (19 cohorts, 1 096 061 individuals, 25 950 cardiovascular disease events), with Harrell's C indices ranging from 0•685 (95% CI 0•629-0•741) to 0•833 (0•783-0•882). For a given risk factor profile, we found substantial variation across global regions in the estimated 10-year predicted risk. For example, estimated cardiovascular disease risk for a 60-year-old male smoker without diabetes and with systolic blood pressure of 140 mm Hg and total cholesterol of 5 mmol/L ranged from 11% in Andean Latin America to 30% in central Asia. When applied to data from 79 countries (mostly low-income and middle-income countries), the proportion of individuals aged 40-64 years estimated to be at greater than 20% risk ranged from less than 1% in Uganda to more than 16% in Egypt. Interpretation We have derived, calibrated, and validated new WHO risk prediction models to estimate cardiovascular disease risk in 21 Global Burden of Disease regions. The widespread use of these models could enhance the accuracy, practicability, and sustainability of efforts to reduce the burden of cardiovascular disease worldwide.

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Section: Introductionmentioning

confidence: 99%

World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions

Kaptoge¹,

Pennells²,

Bacquer³

et al. 2019

The Lancet Global Health

Self Cite

626

459

View full text Add to dashboard Cite

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“…However, we recently completed a systematic review that identified multiple evidence gaps pertaining to the best strategies for implementing these risk estimates in clinical practice (Karmali et al, 2017). One commonly cited limitation in prior studies was missing or incomplete risk factor data at the time of a clinical encounter.…”

Section: Discussionmentioning

confidence: 99%

Point-of-care testing to promote cardiovascular disease risk assessment: A proof of concept study

Karmali

Brown

Sanchez

et al. 2017

Preventive Medicine Reports

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Updated cholesterol guidelines emphasize multivariable cardiovascular disease (CVD) risk estimation to guide treatment decision-making in primary prevention. This study tested the preliminary feasibility, acceptability and efficacy of point-of-care testing (POCT) and quantitative CVD risk assessment in high-risk adults to increase guideline-recommended statin use in primary prevention. Participants were aged 40–75 years, without CVD or diabetes mellitus, and potentially-eligible for consideration of statins based on estimated 10-year CVD risk from last-measured risk factor levels in the electronic health record. We performed POCT to facilitate quantitative CVD risk assessment with the Pooled Cohort Equations immediately before a scheduled primary care provider (PCP) visit. Outcomes were: physician documentation of a CVD risk discussion and statin prescription on the study date. We also assessed acceptability of the intervention through structured questionnaire. We recruited 18 participants (8 from an academic practice and 10 from a federally-qualified health clinic). After the intervention, 83% of participants discussed CVD risk with their PCP, 47% received a statin recommendation from their PCP, and 29% received a new statin prescription during the PCP visit. Participants reported high levels of satisfaction with the intervention. This study demonstrates that in initial testing pre-visit POCT and quantitative CVD risk assessment appears to be a feasible and acceptable intervention that may promote guideline-recommended statin initiation in primary prevention. Future research with an adequately powered trial is warranted to determine the effectiveness of this approach in clinical practice.

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“…Confirming of the utility of preventive approaches in midlife, a recent Cochrane review including 41 randomized controlled trials totalling 194,035 participants showed that providing cardiovascular risk scores reduced total cholesterol and systolic blood pressure as compared with usual care 44 . Moreover, providing cardiovascular risk scores may increase preventive medication prescribing (lipid-lowering therapy and antihypertensive drugs) in highrisk groups 44 . It is therefore logical to imagine that better cardiovascular treatment could limit cardiovascular events and their functional consequences.…”

Section: • Midlife Prevention Of Non-communicable Diseases and Age-rementioning

confidence: 99%

Integrating functional ageing into daily clinical practice

Michel

Ecarnot

2019

JFSF

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Health Organization (WHO) during the 54TH World Health Assembly on 22 May 2001 5 , and the 2015 WHO definition of healthy ageing as "the process of developing and maintaining functional ability which enables well-being in older age" 6 , this article aims to underscore, yet again, the importance of integrating daily functioning into the clinical practice of all health professionals caring for middle-aged and older adults. The personal life trajectory of these individuals is a unique and complex set of intermingled relations between intrinsic capacity, lifestyles and environment, all of which greatly influence individual functioning.

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Risk scoring for the primary prevention of cardiovascular disease

Cited by 102 publications

References 166 publications

World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions

World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions

Point-of-care testing to promote cardiovascular disease risk assessment: A proof of concept study

Integrating functional ageing into daily clinical practice

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