Comparative assessment of absolute cardiovascular disease risk characterization from non-laboratory-based risk assessment in South African populations

BMC Medicine

Ria Laubscher¹  Dorcas R Prakaschandra²  Datshana P Naidoo⁷  Aletta E Schutte⁶  Annamarie Kruger⁵  Ayesha A Motala^1,12  Corinna M Walsh⁸  Gina Joubert³  Willie Mollentze^1,11  Naomi Levitt⁴  Krisela Steyn⁴  Ankur Pandya⁹  Thomas A Gaziano^1,10 

[1] Biostatistics Unit, Medical Research Council, Francie van Zijl Drive, Tygerberg 7505, South Africa;Department of Biomedical and Clinical Technology, Durban University of Technology, University of KwaZulu-Natal, Mazisi Kunene Road, Durban 4041, South Africa;Department of Biostatistics, University of the Free State, 205 Nelson Mandela Drive, Park West, Bloemfontein 9301, South Africa;Department of Medicine, University of Cape Town, Observatory, Cape Town 7925, South Africa;Faculty of Health Sciences-Africa Unit for Transdisciplinary Health Research, North-West University, Hofman Street, Potchefstroom 2531, South Africa;Hypertension in Africa Research Team, North-West University, Potchefstroom 2531, South Africa;Department of Cardiology, University of KwaZulu-Natal, Inkosi Albert Luthuli Central Hospital, Bellair Road, Durban 4041, South Africa;School of Tourism, Hospitality and Sport, Technikon Free State, 20 President Boshof Street, Bloemfontein 9320, South Africa;Department of Public Health, Division of Health Policy, Weill Cornell Medical College, 402 E. 67th Street, New York, NY 10065, USA;Chronic Diseases Initiative for Africa, Department of Medicine, University of Cape Town, Observatory, Cape Town 7925, South Africa;Department of Internal Medicine, School of Medicine, University of the Free State, 205 Nelson Mandela Drive, Park West, Bloemfontein 9301, South Africa;Department of Endocrinology, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Mazisi Kunene Road, Durban 4041, South Africa

关键词: Coronary heart disease;    Stroke;    Cholesterol;    Prevention;    Cardiovascular disease;   

Others  :  856953
DOI  :  10.1186/1741-7015-11-170

 received in 2012-12-01, accepted in 2013-06-27,  发布年份 2013

【 摘 要 】

Background

All rigorous primary cardiovascular disease (CVD) prevention guidelines recommend absolute CVD risk scores to identify high- and low-risk patients, but laboratory testing can be impractical in low- and middle-income countries. The purpose of this study was to compare the ranking performance of a simple, non-laboratory-based risk score to laboratory-based scores in various South African populations.

Methods

We calculated and compared 10-year CVD (or coronary heart disease (CHD)) risk for 14,772 adults from thirteen cross-sectional South African populations (data collected from 1987 to 2009). Risk characterization performance for the non-laboratory-based score was assessed by comparing rankings of risk with six laboratory-based scores (three versions of Framingham risk, SCORE for high- and low-risk countries, and CUORE) using Spearman rank correlation and percent of population equivalently characterized as ‘high’ or ‘low’ risk. Total 10-year non-laboratory-based risk of CVD death was also calculated for a representative cross-section from the 1998 South African Demographic Health Survey (DHS, n = 9,379) to estimate the national burden of CVD mortality risk.

Results

Spearman correlation coefficients for the non-laboratory-based score with the laboratory-based scores ranged from 0.88 to 0.986. Using conventional thresholds for CVD risk (10% to 20% 10-year CVD risk), 90% to 92% of men and 94% to 97% of women were equivalently characterized as ‘high’ or ‘low’ risk using the non-laboratory-based and Framingham (2008) CVD risk score. These results were robust across the six risk scores evaluated and the thirteen cross-sectional datasets, with few exceptions (lower agreement between the non-laboratory-based and Framingham (1991) CHD risk scores). Approximately 18% of adults in the DHS population were characterized as ‘high CVD risk’ (10-year CVD death risk >20%) using the non-laboratory-based score.

Conclusions

We found a high level of correlation between a simple, non-laboratory-based CVD risk score and commonly-used laboratory-based risk scores. The burden of CVD mortality risk was high for men and women in South Africa. The policy and clinical implications are that fast, low-cost screening tools can lead to similar risk assessment results compared to time- and resource-intensive approaches. Until setting-specific cohort studies can derive and validate country-specific risk scores, non-laboratory-based CVD risk assessment could be an effective and efficient primary CVD screening approach in South Africa.

【 授权许可】

   
2013 Gaziano et al.; licensee BioMed Central Ltd.

【 图 表 】

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