Evaluating Cardiovascular Disease (CVD) risk scores for participants with known CVD and non-CVD in a multiracial/ethnic Caribbean sample

Background

Cardiovascular Disease (CVD) risk prediction models have been useful in estimating if individuals are at low, intermediate, or high risk, of experiencing a CVD event within some established time frame, usually 10 years. Central to this is the concern in Trinidad and Tobago of using pre-existing CVD risk prediction methods, based on populations in the developed world (e.g. ASSIGN, Framingham and QRISK^®2), to establish risk for its multiracial/ethnic Caribbean population. The aim of this study was to determine which pre-existing CVD risk method is best suited for predicting CVD risk for individuals in this population.

Method

A survey was completed by 778 participants, 526 persons with no prior CVD, and 252 who previously reported a CVD event. Lifestyle and biometric data was collected from non-CVD participants, while for CVD participants, medical records were used to collect data at the first instance of CVD. The performances of three CVD risk prediction models (ASSIGN, Framingham and QRISK^®2) were evaluated using their calculated risk scores.

Results

All three models (ASSIGN, Framingham and QRISK^®2) identified less than 62% of cases (CVD participants) with a high proportion of false-positive predictions to true predictions as can be seen by positive predictabilities ranging from 78% (ASSIGN and Framingham) to 87% (QRISK^®2). Further, for all three models, individuals whose scores fell into the misclassification range were 2X more likely to be individuals who had experienced a prior CVD event as opposed to healthy individuals.

Conclusion

The ASSIGN, Framingham and QRISK^®2 models should be utilised with caution on a Trinidad and Tobago population of intermediate and high risk for CVD since these models were found to have underestimated the risk for individuals with CVD up to 2.5 times more often than they overestimated the risk for healthy persons.

Changes on Walking During Street Crossing Situations and on Dorsiflexion Strength of Older Caribbean Americans After an Exercise Program: A Pilot Study

The objective of this pilot study was to evaluate a 6-month exercise program completed by 10 older Caribbean Americans. Assessments were done at baseline and 3 and 6 months, and included walks on an instrumented mat at preferred speed, and during street crossing simulations with regular (10 s) and reduced time (5 s). There were no significant differences on preferred walking speed over time. Differences between the street crossing conditions were found only at 6 months. Significant changes over time among the assessments were found only during street crossing with reduced time. Street crossing with reduced time was the only walking condition sensitive to capture changes associated with participating in the exercise program. There was a significant increase in dorsiflexion strength overtime. At 6 months it was significantly higher than at baseline and 3 months. The program was feasible, acceptable, and had some positive effects on walking, knee flexion, and dorsiflexion strength.

African American and Black Caribbean Feelings of Closeness to Africans

African American and Black Caribbean relations dominate research on interactions across black ethnic divides. Using National Survey of American Life data, we explore a different aspect of black interethnic attitudes: how close these groups feel toward Africans. African Americans and Black Caribbeans were largely similar in their feelings of closeness to Africans. For Black Caribbeans, younger and male respondents, those reporting higher levels of financial strain, living in the northeast and persons who immigrated to the United States at least 11 years ago, report feeling especially close to Africans. Being male was the only significant correlate among African Americans. The findings are discussed in relation to how race, ethnicity and national origin shape personal identities within the U.S. and their significance for intergroup perceptions. These broader issues warrant further consideration in light of assertions that race as a defining feature of American life and intergroup relations is obsolete.