WHO Non-Lab-Based CVD Risk Assessment: A Reliable Measure in a North Indian Population

Abstract

Introduction: Timely, affordable, and sustained interventions reduce the risk of heart attack or Stroke in people with a high total risk of cardiovascular diseases (CVD). Risk prediction tools are available to estimate the cardiovascular risk using information on multiple variables. CVD risk charts prepared by the World Health Organization (WHO) has laboratory-based and non-laboratory-based charts with the latter meant for use in resource limited settings. We conducted a study to determine concordance between the laboratory-and non-laboratory risk charts and to estimate the prevalence of selected CVD risk factors in a rural Indian population. Methods:A community-based cross-sectional study was conducted in rural area of Ballabgarh in district Faridabad, Haryana. Sample of 1,018 participants aged 30-69 years was selected randomly from study area. Information on CVDs risk factors was obtained using WHO STEPS questionnaire, anthropometry and laboratory investigation. Risk distribution among the study participants was observed. Concordance between laboratory-and non-laboratory-based WHO CVD risk charts was determined using agreement analysis. Results:The mean age of the study participants was 43.9 (8.9) years and 55.6% participants were women. Among various CVD risk factors, hypertension (39.4%) was the major factor followed by overweight (34.1%) was found to be major factor, followed by current smoking (23.6%) and hypercholesterolemia (18.7%). The concordance between the two charts was 83.3% with kappa value of 0.64. Considering laboratorybased charts as the gold standard, the sensitivity and specificity of non-laboratorybased risk charts at 5% risk as cut-off was 86.5% and 90.3% respectively. Conclusion:The study shows a good agreement between the laboratory-based and non-laboratory-based risk charts. Thus non-laboratory-based risk charts are suitable for risk estimation of CVDs for use in resource limited settings like India.

The Role of Noncommunicable Disease Clinics in Improving Control of Hypertension and Diabetes Among Adults Residing in Rural Ballabgarh, Haryana

“…This is useful in setting with poor availability of laboratory services. A study conducted in North India showed good agreement between the WHO laboratory and non-laboratory CVD risk score [ 13 ]. BP and FBS/RBS were measured monthly at each follow-up visit.…”

“I Would Rather Die Drinking than take the Medicine”: Role of Alcohol Use Disorder in Loss-to-follow-up of Tuberculosis Treatment in a Rural Area of Ballabgarh, Haryana

“…In this area, the TB treatment LTFU has previously been found to be between 11% and 14%,[ 3 6 ] and the current alcohol consumption among men has been reported to be 30% (in stark contrast to current alcohol use among women—0.2%). [ 13 14 ] Two out of nine TUs of district Faridabad viz. TUs Ballabgarh and Mohna were purposively selected.…”

Estimation of 10‐year cardiovascular risk among adult population in western Nepal using nonlaboratory‐based WHO/ISH chart, 2023: A cross‐sectional study

“…In limited resource settings like Nepal where there is limited availability of laboratory facilities, a nonlaboratory‐based CVD risk prediction chart can be used as an appropriate tool for estimating the risk of CVDs. Many studies have already reported that nonlaboratory‐based WHO/ISH risk prediction charts work almost as accurately as laboratory‐based prediction charts 9,12,13 …”

“…Other examples of CVD risk prediction charts are PROCAM, Systematic Coronary Risk Evaluation (SCORE), Reynold Risk Score, QRISK, and so forth. However, the majority of these charts are based on developed high‐income countries thus they may not be applicable in settings with low resources 9,10 . In 2007, the WHO in collaboration with the International Society of Hypertension (ISH) developed a risk prediction chart for estimating the 10‐year risk of major fatal or nonfatal cardiovascular events.…”

“…Many studies have already reported that nonlaboratory-based WHO/ISH risk prediction charts work almost as accurately as laboratory-based prediction charts. 9,12,13 In 2017, Khanal et al 14 conducted a study to estimate 10-year total cardiovascular risk among the Nepalese population using laboratory-based WHO/ISH risk prediction chart and reported that the low, moderate, and high CVD risk were 86.4%, 9.3%, and 4.3%, respectively. Another laboratory-based risk estimation study from Nepal reported >10% CVD risk in 14.6% of respondents.…”