Comparison of laboratory-based and non-laboratory-based WHO cardiovascular disease risk charts: a population-based study

Comparison of WHO laboratory-based and non-laboratory-based CVD risk charts among hypertensive adults attending primary healthcare centers in West Africa sub-region

BACKGROUND

The World Health Organization (WHO) non-laboratory cardiovascular disease (CVD) risk chart is sub-region-specific and is advocated in resource-constrained settings. However, the extent of agreement with laboratory-based assessment among hypertensive adults attending primary health centers (PHCs) in the West Africa sub-region remains unknown. This study compared 10-year CVD risk among adults with hypertension attending PHCs in Ghana and Nigeria.

MATERIALS AND METHODS

This cross-sectional study recruited 319 adults with hypertension at PHCs in Ghana and Nigeria. All participants had their blood pressure, anthropometrics, fasting blood sugar, and fasting cholesterol measured following standard procedures. WHO laboratory and non-laboratory CVD risks were assessed and compared using Kappa statistics, correlation, and Bland-Altman Plot.

RESULTS

The median (interquartile range) for laboratory-based and non-laboratory-based CVD risk scores were comparable [7.0 (4.0 11.0) vs. 7.0 (4.0 to 11.0), p = 0.914]. Of the 319 participants, laboratory-based assessment classified 214 (67.1%) as low risk, while 210 (65.8%) were classified as low risk using the non-laboratory method. Eleven (3.4%) and 14 (4.4%) participants were classified as high-risk using laboratory- and non-laboratory-based methods, respectively. Overall, there was a very good positive correlation between the CVD risk assessment methods (r = 0.948, p<0.001). For all participants combined, there was substantial agreement (Kappa statistics), with K = 0.766. Bland-Altman showed a mean bias of 0.15 (SD = 1.74) in favor of non-laboratory-based assessment of CVD with an upper limit of 3.57 and a lower limit of -3.26.

CONCLUSION

There was substantial agreement between laboratory- and non-laboratory-based WHO CVD risk charts in this study. In low-resource settings, such as Ghana and Nigeria, the WHO non-laboratory CVD risk prediction model offers a huge opportunity for primary CVD prevention in adults with hypertension.

Development of a Digestive Cancer Risk Score Based on Nutritional Predictors: A Risk Prediction Model in the Golestan Cohort Study

This study aimed to develop a non-laboratory simple and useful scoring system to predict risk of incident digestive cancers within the healthcare and clinical framework in Iranian population. The present study was conducted on the collected data from the Golestan Cohort Study. A total of 49,173 participants, aged 37-80 years, were recruited from Gonbad City and 326 rural villages and were followed from 2004 to 2021 in Iran. A non-laboratory model for prediction of the 15-year risk of digestive cancers by means of dietary predictors and formulating a simple and useful scoring system in Iranian population was done in this study. A total of 43550 participants (25249 women and 18301 men) were included in the final analysis. The model's discrimination and calibration were assessed by concordance statistic (C-statistic) and calibration plot, respectively. The model had an acceptable discrimination in both derivation (C-statistic: 0.76) and validation (C-statistic: 0.70) samples (p < 0.001). Also, the calibration of model in derivation and validation datasets was 0.88 and 0.91, respectively. As an assessment tool, the established simple and practical nutritional risk score is suitable for motivating at-risk individuals to change lifestyles and dietary patterns to reduce future risks and prevent health problems.

Discrimination and calibration performances of non-laboratory-based and laboratory-based cardiovascular risk predictions: a systematic review

BACKGROUND AND OBJECTIVE

This review compares non-laboratory-based and laboratory-based cardiovascular disease (CVD) risk prediction equations in populations targeted for primary prevention.

DESIGN

Systematic review.

METHODS

We searched five databases until 12 March 2024 and used prediction study risk of bias assessment tool to assess bias. Data on hazard ratios (HRs), discrimination (paired c-statistics) and calibration were extracted. Differences in c-statistics and HRs were analysed.

PROTOCOL

PROSPERO (CRD42021291936).

RESULTS

Nine studies (1 238 562 participants, 46 cohorts) identified six unique CVD risk equations. Laboratory predictors (eg, cholesterol and diabetes) had strong HRs, while body mass index in non-laboratory models showed limited effect. Median c-statistics were 0.74 for both models (IQR: lab 0.77-0.72; non-lab 0.76-0.70), with a median absolute difference of 0.01. Calibration measures between laboratory-based and non-laboratory-based equations were similar, although non-calibrated equations often overestimated risk.

CONCLUSION

The discrimination and calibration measures between laboratory-based and non-laboratory-based models show minimal differences, demonstrating the insensitivity of c-statistics and calibration metrics to the inclusion of additional predictors. However, in most reviewed studies, the HRs for these additional predictors were substantial, significantly altering predicted risk, particularly for individuals with higher or lower levels of these predictors compared with the average.

Comparison of laboratory-based and non-laboratory-based cardiovascular risk prediction tools in rural India

BACKGROUND

Non-laboratory-based cardiovascular risk prediction tools are feasible alternatives to laboratory-based tools in low- and middle-income countries. However, their effectiveness compared to their laboratory-based counterparts has not been adequately tested.

AIM

We compared estimates from laboratory-based and non-laboratory-based risk prediction tools in a low- and middle-income country setting.

METHODS

Using a cross-sectional design, residents of the Rishi Valley region, Andhra Pradesh, India, were surveyed from 2012 to 2015. Ten-year absolute risk was compared for laboratory-based and non-laboratory-based Framingham Risk Score (FRS), World Health Organization-Risk Score (WHO-RS) and risk prediction tool for global populations (Globorisk). An agreement was assessed using ordinary least-products (OLP) regression (for RS) and quadratic weighted kappa (κw, for risk band).

RESULTS

Among 2847 participants aged 40-74 years, the mean age was 54.0 years. Cardiovascular RS increased with age and was greater in men than women in each age group. For all tools, regardless of whether laboratory or non-laboratory-based, over 80% of the participants were classified in the same risk band. There was strong agreement between laboratory-based and non-laboratory-based tools, greatest for the WHO-RS tools (OLP slope = 0.96, κw = 0.93) and least for the FRS (OLP slope = 0.84, κw = 0.88). The level of agreement was greater among women than men, less in those with hypercholesterolaemia or hypertension than those without, and was particularly poor among those with diabetes.

CONCLUSIONS

Non-laboratory-based Framingham, WHO-RS and Globorisk tools performed relatively well compared with their laboratory-based counterparts in rural India. However, they may be less useful for risk stratification when applied to individuals with diabetes.

Office-based risk equation of Globorisk for prediction of ten-years cardiovascular risk among Iranian population: findings from Fasa PERSIAN cohort study

BACKGROUND

Globorisk is one of the prediction tools for 10-year risk assessment of cardiovascular disease, featuring an office-based (non-laboratory-based) version. This version does not require laboratory tests for determining the CVD risk. The present study aims to determine the 10-year CVD risk using the office-based Globorisk model and factors associated with the 10-year CVD risk.

METHODS

In this study, baseline data from 6810 individuals participating in the Fasa cohort study, with no history of CVD or stroke, were utilized. The risk equation of the office-based Globorisk model incorporates age, sex, systolic blood pressure (SBP), body mass index (BMI), and smoking status. The Globorisk model categorizes the risk into three groups: low risk (< 10%), moderate risk (10% to < 20%), and high risk (≥ 20%). To identify factors associated with the 10-year CVD risk, the predicted risk was categorized into two groups: <10% and ≥ 10%. Multivariable logistic regression analysis was employed to determine factors associated with an increased CVD risk.

RESULTS

According to the 10-year CVD risk categorization, 78.3%, 16.4%, and 5.3% of men were in the low, moderate, and high risk groups, respectively, while 85.8%, 10.0%, and 4.2%, of women were in the respective risk groups. Multivariable logistic regression results indicated that in men, the 10-year CVD risk decreases with being an opium user, and increases with being illiterate, having abdominal obesity, and low or moderate physical activity compared to high physical activity. In women, being married, and higher fiber consumption decrease the 10-year CVD risk, while being illiterate, low or moderate physical activity compared to high physical activity, having abdominal obesity, opium use, and being in wealth quintiles 1 to 4 compared to quintile 5 increase the risk.

CONCLUSIONS

Considering the factors associated with increased CVD risk, there is a need to enhance awareness and modify lifestyle to mitigate and reduce the risk of CVD. Additionally, early identification of individuals at moderate to high risk is essential for preventing disease progression. The use of the office-based Globorisk model can be beneficial in settings where resources are limited for determining the 10-year CVD risk.

Regional and socio-demographic variation in laboratory-based predictions of 10-year cardiovascular disease risk among adults in north and south India

OBJECTIVE

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in India. There is no laboratory-based CVD risk data among Indians from different regions and backgrounds. This study estimated laboratory-based 10-year CVD risk across different population sub-groups.

METHODS

Data from UDAY derived from cross-sectional surveys of rural and urban populations of northern (Haryana) and southern (Andhra Pradesh) India were analysed. World Health Organization/International Society of Hypertension laboratory-based equations calculated 10-year CVD risk among participants without CVD history. Wilcoxon rank sum test analyzed average CVD risk across subgroups. Chi-square test compared population proportions in different CVD risk categories. Regression analysis assessed the association between CVD risk and participant characteristics.

RESULTS

The mean (SD) age of the participants (n = 8448) was 53.2 (9.2) years. Males in Haryana had increased CVD risk compared to those in Andhra Pradesh (p < 0.01). In both states, female gender was shown to have a protective effect on CVD risk (p < 0.01). Age correlated with increased risk (p < 0.01). Education level did not affect CVD risk however employment status may have. Hypertension, diabetes, hyperlipidemia, smoking, and insufficient exercise were associated with increased CVD risk (p < 0.01). Residence (urban versus rural) and wealth index did not largely affect CVD risk.

CONCLUSION

Minor differences exist in the distribution of laboratory-based CVD risk across Indian population cohorts. CVD risk was similar in urban wealthy participants and rural poor and working-class communities in northern and southern India. Public health efforts need to target all major segments of the Indian population to curb the CVD epidemic.

Association between health literacy and Framingham risk score

High health literacy (HL) plays a critical role in preventing or delaying the onset of cardiovascular diseases (CVDs) and can improve disease management and control. The present study aims to determine the association between HL and non-laboratory-based (office-based) Framingham 10-year risk score of CVD. This cross-sectional study was conducted on 648 people aged 30-65 in the health centers of Jahrom. The Health Literacy Instrument for Adults (HELIA) was used to assess HL. The non-laboratory-based Framingham risk score (FRS) was utilized to determine the 10-year risk of CVDs. Risk factors such as age, gender, diabetes, current smoking status, systolic blood pressure (SBP), hypertension (HTN) treatment, and body mass index (BMI) were applied in the non-laboratory-based model. The average age of the subjects was 44.7 ± 10.5 years, among which 49.2% were males. The prevalence of diabetes, HTN, and smoking equaled 8.5%, 15.7%, and 10%, respectively. In addition, the average BMI was 26.1 ± 3.6 kg/m2. Based on the non-laboratory-based Framingham 10-year risk score of CVD, 72.5%, 13.9%, and 13.6% of the subjects were in the low, moderate, and high risk groups, respectively. Based on the HL grouping, the levels of insufficient, borderline, sufficient, and excellent HL were 19.3%, 26.4%, 34.6%, and 19.7%, respectively. A significant association was observed between 10-year CVD risk and HL grouping. In addition, a negative correlation was reported at the individual level between HL and non-laboratory-based FRS among the whole population (r = - 0.39, p < 0.001), men (r = - 0.32, p < 0.001), and women (r = - 0.42, p < 0.001). A higher HL score is associated with a lower risk of CVD. In addition, the adjusted logistic regression analysis showed that there was a strong association between elevated CVD risk (≥ 10%) and HL (OR 6.1, 95% CI 2.9-12.6) among inadequate HL participants compared with excellent HL individuals. Thus, designing and implementing training programs to increase HL, especially among those who are at risk of CVDs, should be regarded as an important issue for the prevention of such diseases.

Performance of the non-laboratory based 2019 WHO cardiovascular disease risk prediction chart in Eastern Sub-Saharan Africa

BACKGROUND AND AIMS

The World Health Organization (WHO) updated its cardiovascular disease (CVD) risk prediction charts in 2019 to cover 21 global regions. We aimed to assess the performance of an updated non-lab-based risk chart for people with normoglycaemia, impaired fasting glucose (IFG), and diabetes in Eastern Sub-Saharan Africa.

METHODS AND RESULTS

We used data from six WHO STEPS surveys conducted in Eastern Sub-Saharan Africa between 2012 and 2017. We included 9857 participants aged 40-69 years with no CVD history. The agreement between lab- and non-lab-based charts was assessed using Bland-Altman plots and Cohen's kappa. The median age of the participants was 50 years (25-75th percentile: 44-57). The pooled median 10-year CVD risk was 3 % (25-75th percentile: 2-5) using either chart. According to the estimation, 7.5 % and 8.4 % of the participants showed an estimated CVD risk ≥10 % using the non-lab-based chart or the lab-based chart, respectively. The concordance between the two charts was 91.3 %. The non-lab-based chart underestimated the CVD risk in 57.6 % of people with diabetes. In the Bland-Altman plots, the limits of agreement between the two charts were widest among people with diabetes (-0.57-7.54) compared to IFG (-1.75-1.22) and normoglycaemia (-1.74-1.06). Kappa values of 0.79 (substantial agreement), 0.78 (substantial agreement), and 0.43 (moderate agreement) were obtained among people with normoglycaemia, IFG, and diabetes, respectively.

CONCLUSIONS

Given limited healthcare resources, the updated non-lab-based chart is suitable for CVD risk estimation in the general population without diabetes. Lab-based risk estimation is suitable for individuals with diabetes to avoid risk underestimation.

Population-wide impact of a pragmatic program to identify and manage individuals at high-risk of cardiovascular disease: a cluster randomized trial in 120 villages from Northern China

Objectives

To explore the population-wide impacts of an evidence-based high-risk strategy for prevention of cardiovascular diseases in resource-poor populations.

Methods

A cluster randomized controlled trial was conducted among 120 villages in rural China, with 60 on intervention and 60 on usual care as controls, for 2 years. The intervention emphasized training village doctors to identify high-risk individuals and administering standardized treatments focusing on hypertension management. A random sample of 20 men aged ≥50 years and 20 women aged ≥60 years was drawn from each village before randomization for the baseline survey, and another independent random sample with the same age and sex distribution was drawn at 2 years for the post-intervention survey. The primary outcome was the population mean systolic blood pressure (SBP). Secondary outcomes included the proportions of patients who received regular primary care, antihypertensive medications, aspirin, or lifestyle advice.

Results

A total of 5,654 high cardiovascular risk individuals were identified and managed by village doctors in intervention villages for 15 months on average, with mean SBP lowered by 19.8 mmHg and the proportion with blood pressure under control increased from 22.1% to 72.7%. The primary analysis of the two independent samples (5,050 and 4,887 participants each) showed that population-wide mean SBP in intervention villages did not differ from that in control villages at 2 years (mean difference = 1.0 mmHg, 95% CI: -2.19, 4.26; P = 0.528), though almost all secondary outcomes concerning primary care indicators significantly increased in intervention villages.

Conclusions

In our study, the pragmatic cardiovascular risk management program targeting on high-risk individuals significantly improved the quality of primary care. However, its impact on population blood pressure level and the burden of hypertension-related diseases appeared very limited.

Clinical Trial Registration

ClinicalTrial.gov identifier, NCT01259700.

Comparison of the performance of cardiovascular risk prediction tools in rural India: the Rishi Valley Prospective Cohort Study

AIMS

We compared the performance of cardiovascular risk prediction tools in rural India.

METHODS AND RESULTS

We applied the World Health Organization Risk Score (WHO-RS) tools, Australian Risk Score (ARS), and Global risk (Globorisk) prediction tools to participants aged 40-74 years, without prior cardiovascular disease, in the Rishi Valley Prospective Cohort Study, Andhra Pradesh, India. Cardiovascular events during the 5-year follow-up period were identified by verbal autopsy (fatal events) or self-report (non-fatal events). The predictive performance of each tool was assessed by discrimination and calibration. Sensitivity and specificity of each tool for identifying high-risk individuals were assessed using a risk score cut-off of 10% alone or this 10% cut-off plus clinical risk criteria of diabetes in those aged >60 years, high blood pressure, or high cholesterol. Among 2333 participants (10 731 person-years of follow-up), 102 participants developed a cardiovascular event. The 5-year observed risk was 4.4% (95% confidence interval: 3.6-5.3). The WHO-RS tools underestimated cardiovascular risk but the ARS overestimated risk, particularly in men. Both the laboratory-based (C-statistic: 0.68 and χ2: 26.5, P = 0.003) and non-laboratory-based (C-statistic: 0.69 and χ2: 20.29, P = 0.003) Globorisk tools showed relatively good discrimination and agreement. Addition of clinical criteria to a 10% risk score cut-off improved the diagnostic accuracy of all tools.

CONCLUSION

Cardiovascular risk prediction tools performed disparately in a setting of disadvantage in rural India, with the Globorisk performing best. Addition of clinical criteria to a 10% risk score cut-off aids assessment of risk of a cardiovascular event in rural India.

LAY SUMMARY

In a cohort of people without prior cardiovascular disease, tools used to predict the risk of cardiovascular events varied widely in their ability to accurately predict who would develop a cardiovascular event.The Globorisk, and to a lesser extent the ARS, tools could be appropriate for this setting in rural India.Adding clinical criteria, such as sustained high blood pressure, to a cut-off of 10% risk of a cardiovascular event within 5 years could improve identification of individuals who should be monitored closely and provided with appropriate preventive medications.

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

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.

Temporal trends of thyroid cancer between 2010 and 2019 in Asian countries by geographical region and SDI, comparison with global data

Objective

This study aims to describe temporal trends of thyroid cancer (ThC) from 2010 to 2019, in Asian countries by geographical region and sociodemographic index, compared with global data.

Method

Annual case data and age-standardized rates (ASRs) of epidemiological indicators of ThC cancer data were collected from the 2019 Global Burden of Disease (GBD) study from 2010 to 2019 in 49 countries and territories in Asia. The relative difference (%) between years was used to show comparative variations of ASRs for the indicators studied. The female/male ratio was calculated by dividing female ASRs by male ASRs. Also, these rates were compared between the age group ≥70 years old and younger age groups.

Results

In 2019, more than 50% of ThC cases and deaths occurred in Asian countries. A total of 53% of ThC patients lived in Asia and more than 60% of the global burden of ThC was imposed on Asian countries. From 2010 to 2019, incidences, deaths, prevalence cases, and DALYs number of ThC cancer increased over 1.28-, 1.26-, 1.3-, and 1.2-fold, in Asia, respectively. During this period, the age-standardized incidence rate (ASIR) and the age-standardized prevalence rate (ASPR) of ThC cancer increased by 5% and 8%, respectively, while the age-standardized death rate (ASDR) and the age-standardized DALYs rate (DALYs ASR) of ThC cancer decreased by 6% and 4%, respectively. These trends are different from what happens in other continents. In 2019, age-specific incidence, death, prevalence, and DALY cases of ThC cancer were peaking at 50-54, 75-79, 50-54, and 55-59 years, respectively. In 2019, the highest ASIR and ASPR of ThC cancer was observed in high-income Asia Pacific countries and the highest ASDR and DALYs ASR in Southeast Asia countries. Only high-income Asia Pacific countries experienced a decreasing trend in ASIR and ASPR from 2010 to 2019. ASDR and DALYs ASR have the highest decreasing trend in high-income Asia Pacific. In 2019, among high SDI Asian countries, the Republic of Korea had the highest ASIR and ASPR, and Brunei Darussalam had the highest ASDR and DALYs ASR. The highest ASIR, ASDR, ASPR, and DALY ASR of ThC cancer was found in Lebanon and Malaysia (high-middle SDIs), Vietnam (middle SDIs), and Cambodia and Palestine (low-middle SDIs). Among low SDI Asian countries, Pakistan had the highest ASIR, ASDR, ASPR, and DALY ASR of ThC cancer. All indicators for most countries were higher in women than men.

Conclusion

More than half of the burden of thyroid cancer is imposed on the residents of the Asian continent. Although the incidence and prevalence of this cancer in Asian countries is lower than that of the world, America, and Europe, the highest rate of death from thyroid cancer occurs in Asia and they witness the highest burden of the disease. Therefore, it seems that implementing early detection strategies and increasing access to treatment facilities in Asia is one of the necessities of thyroid cancer control in its residents.

Antibody detection against Kunitz-type protein in Fasciola hepatica experimentally infected sheep using enzyme-linked immunosorbent assay (ELISA)

Fasciolosis is a parasitic disease considered as emerging and neglected by the WHO. Sheep are highly susceptible to this disease, and affected flocks experience decreased productivity due to increased mortality, and the reduced quality of their products, such as wool and meat. To effectively control this disease, reliable and early diagnosis is essential for making decisions regarding antiparasitic application and/or the removal of affected animals. Currently, the diagnosis of F. hepatica in sheep relies on the detection of parasite eggs in faeces, a method that becomes reliable from week 10 post-infection. Consequently, there is a need for earlier diagnostic tools based on immune response. However, obtaining antigens for antibody detection has proven to be difficult and expensive. The aim of this study was to evaluate members of the Kunitz protein family of F. hepatica expressed in the form of a fusion protein in the serological diagnosis of F. hepatica in sheep. The performance of three recombinant F. hepatica Kunitz-type inhibitors (FhKT1.1, FhKT1.3, and FhKT4) was compared with a synthetic Kunitz-type peptide (sFhKT) in sera from sheep experimentally infected with F. hepatica, using an ELISA. Of these, FhKT1.1 showed the most promising diagnostic indicators, exhibiting high precision and low cross-reactivity, and thus potential for standardized production. The results of our study demonstrated that the application of FhKT1.1 is a valuable tool for early-stage diagnosis of F. hepatica in sheep. Such an early diagnosis can aid in implementing timely interventions and effectively managing the disease in sheep populations.

A comparison of laboratory-based and office-based Framingham risk scores to predict 10-year risk of cardiovascular diseases: a population-based study

BACKGROUND

Two versions of Framingham's 10-year risk score are defined for cardiovascular diseases, namely laboratory-based and office-based models. The former is mainly employed in high-income countries, but unfortunately, it is not cost-effective or practical to utilize it in countries with poor facilities. Therefore, the present study aims to identify the agreement and correlation between laboratory-based and office-based Framingham models.

METHODS

Using laboratory-based and office-based Framingham models, this cross-sectional study used data from 8944 participants without a history of CVDs and stroke at baseline in the Fasa cohort study to predict the 10-year risk of CVDs. The laboratory-based model included age, sex, diabetes, smoking status, systolic blood pressure (SBP), treatment of hypertension, total cholesterol, and high-density lipoprotein (HDL); and the office-based model included age, sex, diabetes, smoking status, SBP, treatment of hypertension, and body mass index (BMI). The agreement between risk categories of laboratory-based and office-based Framingham models (low [< 10%], moderate [from 10 to < 20%], high [≥ 20%]) was assessed by kappa coefficients and percent agreement. Then, the correlation between the risk scores was estimated using correlation coefficients and illustrated using scatter plots. Finally, agreements, correlation coefficient, and scatter plots for laboratory-based and office-based Framingham models were analyzed by stratified Framingham risk score factors including sex, age, BMI categories, hypertension, smoking, and diabetes status.

RESULTS

The two models showed substantial agreement at 89.40% with a kappa coefficient of 0.75. The agreement was substantial in all men (kappa = 0.73) and women (kappa = 0.72), people aged < 60 years (kappa = 0.73) and aged ≥ 60 years (kappa = 0.69), smokers (kappa = 0.70) and non-smokers (kappa = 0.75), people with hypertension (kappa = 0.73) and without hypertension (kappa = 0.75), diabetics (kappa = 0.71) and non-diabetics (kappa = 0.75), people with normal BMI (kappa = 0.75) and people with overweight and obesity (kappa = 0.76). There was also a very strong positive correlation (r ≥ 0.92) between laboratory-based and office-based models in terms of age, sex, BMI, hypertension, smoking status and diabetes status.

CONCLUSIONS

The current study showed that there was a substantial agreement between the office-based and laboratory-based models, and there was a very strong positive correlation between the risk scores in the entire population as well across subgroups. Although differences were observed in some subgroups, these differences were small and not clinically relevant. Therefore, office-based models are suitable in low-middle-income countries (LMICs) with limited laboratory resources and facilities because they are more convenient and accessible. However, the validity of the office-based model must be assessed in longitudinal studies in LMICs.

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

Background and Aims

Noncommunicable diseases have emerged as a major cause of morbidity and mortality worldwide among which the majority of the deaths are caused by cardiovascular diseases. Estimating the risk of cardiovascular diseases helps eliminate the risk factors and prevent developing cardiovascular diseases in the future. The World Health Organization in association with the International Society of Hypertension has developed risk charts for the estimation of 10-year risk for cardiovascular diseases. This study aimed to estimate 10-year cardiovascular risk in the Nepalese population using nonlaboratory-based charts.

Methods

A hospital-based cross-sectional study was conducted among 314 adults aged 40-74 years visiting the outpatient departments of Shishuwa Hospital in western Nepal. Systematic random sampling was used to select the participants. Questionnaire-guided short interviews, physical examination, and anthropometric measurements were done. The χ 2 test was used to test the significance and a p < 0.05 was considered statistically significant.

Results

As per the risk estimation charts, high cardiovascular risk (20%-30%) was seen in 6.1% of total participants and moderate cardiovascular risk (10%-20%) was found in 29% of participants. The moderate-high risk was significantly higher among male participants compared to females (p < 0.01). Of all the participants, 22.0% were current smokers, 17.2% were alcohol users, 61.1% were hypertensive, and 35.7% were diabetics. Smoking tobacco, alcohol use, and hypertension were significantly more prevalent among the male participants. (p < 0.01) Adults in the 50-59 years age group had a significantly high prevalence of hypertension (p < 0.01), diabetes (p = 0.02), and alcohol abuse (p = 0.01).

Conclusion

This study shows high cardiovascular risk among adult population in western Nepal. The 10-year cardiovascular risk score and risk factors were significantly higher among males than females. There seems to be a prompt necessity of health promotion interventions to reduce cardiovascular risk factors and prevent the burden of cardiovascular diseases in Nepal.

Cardiovascular Disease Risk Screening for Commercial Drivers Examined in Occupational Practice: Implementing Evidence-Based Practice to Champion the Health of Essential Workers

BACKGROUND

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in the United States, with 20% of deaths in adults under age 65. Commercial drivers have an increased CVD incidence rate of 50% compared to 30% for the general population, yet one third of drivers will not be screened for risk factors due to a lack of insurance or primary care. With approximately 3.5 million commercial drivers nationally and correlation of CVD to increased motor vehicle accidents, fatalities, and excessive healthcare costs, addressing the care gap for this high-risk population is imperative.

METHODS

An evidence-based practice (EBP) project synthesized the literature and implemented CVD risk screening for commercial drivers examined in an occupational practice setting. Using the non-laboratory Framingham CVD risk score calculator, over 90% of drivers were screened during mandated medical examinations and provided education regarding modifiable risk factors during a 2-month period.

FINDINGS

Over 40% of commercial drivers were at high risk for CVD with 25% uninsured and 32% without primary care. The average CVD risk score was twice the general population's risk score, with obesity, hypertension, and smoking being the most common risk factors discussed.

CONCLUSIONS/APPLICATION TO PRACTICE

Incorporating CVD risk screening and education during opportune encounters is logical, efficient, and financially prudent. The EBP change supports occupational professionals' standards, and ongoing review of CVD screening guidelines with integration into practice provides health promotion and promotes public safety for these essential workers.

A comparative assessment between Globorisk and WHO cardiovascular disease risk scores: a population-based study

The Globorisk and WHO cardiovascular risk prediction models are country-specific and region-specific, respectively. The goal of this study was to assess the agreement and correlation between the WHO and Globorisk 10-year cardiovascular disease risk prediction models. The baseline data of 6796 individuals aged 40-74 years who participated in the Fasa cohort study without a history of cardiovascular disease or stroke at baseline were included. In the WHO and Globorisk models scores were calculated using age, sex, systolic blood pressure (SBP), current smoking, diabetes, and total cholesterol for laboratory-based risk and age, sex, SBP, current smoking, and body mass index (BMI) for non-laboratory-based risk (office-based or BMI-based). In Globorisk and WHO risk agreement across risk categories (low, moderate, and high) was examined using the kappa statistic. Also, Pearson correlation coefficients and scatter plots were used to assess the correlation between Globorisk and WHO models. Bland-Altman plots were presented for determination agreement between Globorisk and WHO risk scores in individual's level. In laboratory-based models, agreement across categories was substantial in the overall population (kappa values: 0.75) and also for females (kappa values: 0.74) and males (kappa values: 0.76), when evaluated separately. In non-laboratory-based models, agreement across categories was substantial for the whole population (kappa values: 0.78), and almost perfect for among males (kappa values: 0.82) and substantial for females (kappa values: 0.73). The results showed a very strong positive correlation (r ≥ 0.95) between WHO and Globorisk laboratory-based scores for the whole population, males, and females and also a very strong positive correlation (r > 0.95) between WHO and Globorisk non-laboratory-based scores for the whole population, males, and females. In the laboratory-based models, the limit of agreements was better in males (95%CI 2.1 to - 4.2%) than females (95%CI 4.3 to - 7.3%). Also, in the non-laboratory-based models, the limit of agreements was better in males (95%CI 2.9 to - 4.0%) than females (95%CI 3.2 to - 6.1%). There was a good agreement between both the laboratory-based and the non-laboratory-based WHO models and the Globorisk models. The correlation between two models was very strongly positive. However, in the Globorisk models, more people were in high-risk group than in the WHO models. The scatter plots and Bland-Altman plots showed systematic differences between the two scores that vary according to the level of risk. So, for these models may be necessary to modify the cut points of risk groups. The validity of these models must be determined for this population.

Laboratory-based versus non-laboratory-based World Health Organization risk equations for assessment of cardiovascular disease risk

BACKGROUND

The WHO model has laboratory-based and non-laboratory-based versions for 10-year risk prediction of cardiovascular diseases. Due to the fact that in some settings, there may not be the necessary facilities for risk assessment with a laboratory-based model, the present study aimed to determine the agreement between laboratory-based and non-laboratory-based WHO cardiovascular risk equations.

METHODS

In this cross-sectional study, we used the baseline data of 6796 individuals without a history of cardiovascular disease and stroke who participated in the Fasa cohort study. The risk factors of the laboratory-based model included age, sex, systolic blood pressure (SBP), diabetes, smoking and total cholesterol, while the non-laboratory-based model included age, sex, SBP, smoking and BMI. Kappa coefficients was used to determine the agreement between the grouped risk and Bland-Altman plots were used to determine the agreement between the scores of the two models. Sensitivity and specificity of non-laboratory-based model were measured at the high-risk threshold.

RESULTS

In the whole population, the agreement between the grouped risk of the two models was substantial (percent agreement = 79.0%, kappa = 0.68). The agreement was better in males than in females. A substantial agreement was observed in all males (percent agreement = 79.8%, kappa = 0.70) and males < 60 years old (percent agreement = 79.9%, kappa = 0.67). The agreement in males ≥ 60 years old was moderate (percent agreement = 79.7%, kappa = 0.59). The agreement among females was also substantial (percent agreement = 78.3%, kappa = 0.66). The agreement for females < 60 years old, (percent agreement = 78.8%, kappa = 0.61) was substantial and for females ≥ 60 years old, (percent agreement = 75.8%, kappa = 0.46) was moderate. According to Bland-Altman plots, the limit of agreement was (95%CI: -4.2% to 4.3%) for males and (95%CI: -4.1% to 4.6%) for females. The range of agreement was suitable for both males < 60 years (95%CI: -3.8% to 4.0%) and females < 60 years (95%CI: -3.6% to 3.9%). However, it was not suitable for males ≥ 60 years (95% CI: -5.8% to 5.5%) and females ≥ 60 years (95%CI: -5.7% to 7.4%). At the high-risk threshold of 20% in non-laboratory and laboratory-based models, the sensitivity of the non-laboratory-based model was 25.7%, 70.7%, 35.7%, and 35.4% for males < 60 years, males ≥ 60 years, females < 60 years, and females ≥ 60 years, respectively. At the high-risk threshold of 10% in non-laboratory-based and 20% in laboratory-based models, the non-laboratory model has high sensitivity of 100% for males ≥ 60 years, females < 60 years, females ≥ 60 years, and 91.4% for males < 60 years.

CONCLUSION

A good agreement was observed between laboratory-based and non-laboratory-based versions of the WHO risk model. Also, at the risk threshold of 10% to detect high-risk individuals, the non-laboratory-based model has acceptable sensitivity for practical risk assessment and the screening programs in settings where resources are limited and people do not have access to laboratory tests.

Community Health Worker-Led Cardiovascular Disease Risk Screening and Referral for Care and Further Management in Rural and Urban Communities in Rwanda

Cardiovascular disease (CVD) is a global health issue. Low- and middle-income countries (LMICs) are facing early CVD-related morbidity. Early diagnosis and treatment are an effective strategy to tackle CVD. The aim of this study was to assess the ability of community health workers (CHWs) to screen and identify persons with high risks of CVD in the communities, using a body mass index (BMI)-based CVD risk assessment tool, and to refer them to the health facility for care and follow-up. This was an action research study conducted in rural and urban communities, conveniently sampled in Rwanda. Five villages were randomly selected from each community, and one CHW per each selected village was identified and trained to conduct CVD risk screening using a BMI-based CVD risk screening tool. Each CHW was assigned to screen 100 fellow community members (CMs) for CVD risk and to refer those with CVD risk scores ≥10 (either moderate or high CVD risk) to a health facility for care and further management. Descriptive statistics with Pearson's chi-square test were used to assess any differences between rural and urban study participants vis-à-vis the key studied variables. Spearman's rank coefficient and Cohen's Kappa coefficient were mainly used to compare the CVD risk scoring from the CHWs with the CVD risk scoring from the nurses. Community members aged 35 to 74 years were included in the study. The participation rates were 99.6% and 99.4% in rural and urban communities, respectively, with female predominance (57.8% vs. 55.3% for rural and urban, p-value: 0.426). Of the participants screened, 7.4% had a high CVD risk (≥20%), with predominance in the rural community compared to the urban community (8.0% vs. 6.8%, p-value: 0.111). Furthermore, the prevalence of moderate or high CVD risk (≥10%) was higher in the rural community than in the urban community (26.7% vs. 21.1%, p-value: 0.111). There was a strong positive correlation between CHW-based CVD risk scoring and nurse-based CVD risk scoring in both rural and urban communities, 0.6215 (p-value < 0.001) vs. 0.7308 (p-value = 0.005). In regard to CVD risk characterization, the observed agreement to both the CHW-generated 10-year CVD risk assessment and the nurse-generated 10-year CVD risk assessment was characterized as "fair" in both rural and urban areas at 41.6% with the kappa statistic of 0.3275 (p-value < 001) and 43.2% with kappa statistic of 0.3229 (p-value =0.057), respectively. In Rwanda, CHWs can screen their fellow CMs for CVD risk and link those with high CVD risk to the healthcare facility for care and follow-up. CHWs could contribute to the prevention of CVDs through early diagnosis and early treatment at the bottom of the health system.

An Assessment of the Effect of Bariatric Surgery on Cardiovascular Disease Risk in the Chinese Population Using Multiple Cardiovascular Risk Models

BACKGROUND

Many studies have reported that bariatric surgery may reduce postoperative cardiovascular risk in patient with obesity, but few have addressed this risk in the Chinese population.

OBJECTIVE

To assess the impact of bariatric surgery on cardiovascular disease (CVD) risk in the Chinese population using the World Health Organization (WHO) risk model, the Global risk model, and the Framingham Risk Score.

METHODS

We retrospectively analyzed data collected on patient with obesity who underwent bariatric surgery at our institution between March 2009 and January 2021. Their demographic characteristics, anthropometric variables, and glucolipid metabolic parameters were assessed preoperatively and at their 1-year postoperative follow-up. Subgroup analysis compared body mass index (BMI) < 35 kg/m² and BMI ≥ 35 kg/m², as well as gender. We used the 3 models to calculate their CVD risk.

RESULTS

We evaluated 61 patients, of whom 26 (42.62%) had undergone sleeve gastrectomy (SG) surgery and 35 (57.38%) Roux-en-Y gastric bypass (RYGB) surgery. Of the patients with BMI ≥ 35 kg/m², 66.67% underwent SG, while 72.97% with BMI < 35 kg/m² underwent RYGB. HDL levels were significantly higher at 12 months postoperatively relative to baseline. When the models were applied to calculate CVD risk in Chinese patients with obesity, the 1-year CVD risk after surgery were reduced lot compared with the preoperative period.

CONCLUSION

Patient with obesity had significantly lower CVD risks after bariatric surgery. This study also demonstrates that the models are reliable clinical tools for assessing the impact of bariatric surgery on CVD risk in the Chinese population.

Appraisal of Cardiovascular Risk Factors, Biomarkers, and Ocular Imaging in Cardiovascular Risk Prediction

Cardiovascular disease remains a leading cause of death worldwide despite the use of available cardiovascular disease risk prediction tools. Identification of high-risk individuals via risk stratification and screening at sub-clinical stages, which may be offered by ocular screening, is important to prevent major adverse cardiac events. Retinal microvasculature has been widely researched for potential application in both diabetes and cardiovascular disease risk prediction. However, the conjunctival microvasculature as a tool for cardiovascular disease risk prediction remains largely unexplored. The purpose of this review is to evaluate the current cardiovascular risk assessment methods, identifying gaps in the literature that imaging of the ocular microcirculation may have the potential to fill. This review also explores the themes of machine learning, risk scores, biomarkers, medical imaging, and clinical risk factors. Cardiovascular risk classification varies based on the population assessed, the risk factors included, and the assessment methods. A more tailored, standardised and feasible approach to cardiovascular risk prediction that utilises technological and medical imaging advances, which may be offered by ocular imaging, is required to support cardiovascular disease prevention strategies and clinical guidelines.

Laboratory-based and office-based Globorisk scores to predict 10-year risk of cardiovascular diseases among Iranians: results from the Fasa PERSIAN cohort

Background

Globorisk is a novel risk prediction model for predicting cardiovascular disease (CVD). Globorisk is a country-specific risk prediction model that determines CVD risk for all countries. This model has two versions; laboratory-based and office-based. This study aimed to determine the agreement between laboratory-based and office-based models in a large sample of the general population.

Methods

Baseline data from the Fasa cohort study was used for the current study. In total, 6810 participants ≥ 40 years without any history of cardiovascular disease or stroke were included in the study. To determine the laboratory-based risk model, factors include age, sex, current smoking status, history of diabetes, systolic blood pressure (SBP), and total cholesterol. To estimate the office-based risk model, factors were age, sex, current smoking status, SBP, and body mass index (BMI). Kappa statistics was used to distinguish the agreement between grouped scores in these two models. Additionally, correlation coefficients and scatter plots were used to determine the linear correlation between the two models.

Results

In this study 46.53% of the participants were men. The mean age (SD) of participants was 51.08 (7.88) years. Agreements between the two models were moderate and substantial in all women and all men, respectively. The agreement between the two CVD risk groups was 90.15% (kappa = 0.717) in all men, 92.94% (kappa = 0.571) among men aged < 60 years and 77.60% (kappa = 0.645) in men aged ≥ 60 years. The agreement between the two CVD risk groups was 86.68% (kappa = 0.572) among all women, 93.96% (kappa = 0.274) among women aged < 60 years and 62.46% (kappa = 0.422) among women aged ≥ 60 years. A very strong positive correlation (r = 0.94) was found between the two risk scores in all men, and it was similar among men aged < 60 years (r = 0.84) and men aged > 60 years (r = 0.94). Among all women, there was a very strong positive correlation (r = 0.87), and the strong positive correlation remained among < 60 years old (r = 0.76) and women > 60 years old (r = 0.76).

Conclusion

The Globorisk office-based model which is easier to use as it does not require blood testing can determine the risk groups in this population. The Globorisk office-based model may be used for CVD risk screening in low-middle income countries where resources are limited.