Ten years risk assessment of atherosclerotic cardiovascular disease using Astro-CHARM and pooled cohort equation in a south Asian sub-population

Abstract

Background: Atherosclerotic cardiovascular diseases (ASCVD) are on the rise in low and middle-income countries attributed to modern sedentary lifestyle and dietary habits. This has led to the need of assessment of the burden of at-risk population so that prevention measures can be developed. The objective of this study was to assess ten years risk assessment of ASCVD using Astro-CHARM and Pooled Cohort Equation (PCE) in a South Asian subpopulation. Methods: A total of 386 residents of all six districts of Karachi with no ASCVD were enrolled in the study through an exponential non-discriminative referral snowball sampling technique. The inclusion criteria consisted of age 40 years or above and either gender. Study participants were enrolled after obtaining informed written consent and those study participants who were found to have either congenital heart disease or valvular heart diseases or ischemic heart disease were excluded from the study based on initial screening. For the calculation of 10 years risk of ACVD based on Astro-CHARM and PCE, the variables were obtained including medical history and coronary artery calcium and C-reactive protein measurements. Results: Mean estimated 10-year risk of fatal or non-fatal myocardial infarction or stroke as per the Astro-CHARM was 13.98 ± 8.01%, while mean estimated 10-year risk of fatal or non-fatal myocardial infarction or stroke as per the PCE was 22.26 ± 14.01%. Based on Astro-CHARM, 11.14% of the study participants were labeled as having high risk, while PCE estimated 20.73% of study participants as having high risk of ASCVD. Conclusion: Despite the fact that our findings showed substantial differences in ten-year risk of ASCVD between Astro-CHARM and PCE, both calculators can be used to develop a new population and specific risk estimators for this South Asian sub-population. Our study provides the first step towards developing a risk assessment guided decision-making protocol for primary prevention of ASCVD in this population.

Risk of Atherosclerotic Cardiovascular Diseases in various Ethnicities of Pakistan

“…These findings are aligned with the findings of a past study by Ashraf T et al 12 , in their study of non-atherosclerotic Pakistani individuals, 44.87% of Urdu speaking had ≥ 7.5% risk of atherosclerotic event in 10 years followed by Punjabi with 19.23% and high-risk individuals were in the smallest ratio for Sindhi ethnicity. This study along with other studies in this population, 6 , 8 , 10 , 12 estimates a significant risk of ASCVD in Pakistani population, and for subgroups, such as Urdu speaking and Punjabi, it is alarmingly high.…”

“…Studies in the past reported great variations in the incidence and risk of ASCVD among the various ethnic breakups of Pakistan. 10,12,15 We observed that our Urdu speaking community (commonly known as Muhajirs) is at increased risk of development of ASCVD event in the following 10 years period and presence of coronary artery calcium was also higher in this community. Diabetes, smoking, and family history of heart attack was relatively more common in Urdu speaking communities as compared to the other ethnic groups.…”

“…Studies in the past reported great variations in the incidence and risk of ASCVD among the various ethnic breakups of Pakistan. 10 , 12 , 15…”

“…Geographic coverage and ethnic distribution of the recruited individuals were ensured, detailed research methodology is presented elsewhere. 10 …”

“…Geographic coverage and ethnic distribution of the recruited individuals were ensured, detailed research methodology is presented elsewhere. 10 The demographic data (gender, mother tongue, age (years), height (cm), and weight (kg)), lipid profile (total, HDL, and LDL cholesterol), systolic blood pressure measurement, and C-reactive protein (CRP) were obtained. History of the patients regarding traditional risk factors were obtained as per user guide of Astro-CHARM Calculator.…”