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Assessment of total cardiovascular risk using WHO/ISH risk prediction charts in three low and middle income countries in Asia

BACKGROUND: Recent research has used cardiovascular risk scores intended to estimate “total cardiovascular disease (CVD) risk” in individuals to assess the distribution of risk within populations. The research suggested that the adoption of the total risk approach, in comparison to treatment decisio...

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Autores principales: Otgontuya, Dugee, Oum, Sophal, Buckley, Brian S, Bonita, Ruth
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3679976/
https://www.ncbi.nlm.nih.gov/pubmed/23734670
http://dx.doi.org/10.1186/1471-2458-13-539
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author Otgontuya, Dugee
Oum, Sophal
Buckley, Brian S
Bonita, Ruth
author_facet Otgontuya, Dugee
Oum, Sophal
Buckley, Brian S
Bonita, Ruth
author_sort Otgontuya, Dugee
collection PubMed
description BACKGROUND: Recent research has used cardiovascular risk scores intended to estimate “total cardiovascular disease (CVD) risk” in individuals to assess the distribution of risk within populations. The research suggested that the adoption of the total risk approach, in comparison to treatment decisions being based on the level of a single risk factor, could lead to reductions in expenditure on preventive cardiovascular drug treatment in low- and middle-income countries. So that the patient benefit associated with savings is highlighted. METHODS: This study used data from national STEPS surveys (STEPwise Approach to Surveillance) conducted between 2005 and 2010 in Cambodia, Malaysia and Mongolia of men and women aged 40–64 years. The study compared the differences and implications of various approaches to risk estimation at a population level using the World Health Organization/International Society of Hypertension (WHO/ISH) risk score charts. To aid interpretation and adjustment of scores and inform treatment in individuals, the charts are accompanied by practice notes about risk factors not included in the risk score calculations. Total risk was calculated amongst the populations using the charts alone and also adjusted according to these notes. Prevalence of traditional single risk factors was also calculated. RESULTS: The prevalence of WHO/ISH “high CVD risk” (≥20% chance of developing a cardiovascular event over 10 years) of 6%, 2.3% and 1.3% in Mongolia, Malaysia and Cambodia, respectively, is in line with recent research when charts alone are used. However, these proportions rise to 33.3%, 20.8% and 10.4%, respectively when individuals with blood pressure > = 160/100 mm/Hg and/or hypertension medication are attributed to “high risk”. Of those at “moderate risk” (10- < 20% chance of developing a cardio vascular event over 10 years), 100%, 94.3% and 30.1%, respectively are affected by at least one risk-increasing factor. Of all individuals, 44.6%, 29.0% and 15.0% are affected by hypertension as a single risk factor (systolic ≥ 140 mmHg or diastolic ≥ 90 mmHg or medication). CONCLUSIONS: Used on a population level, cardiovascular risk scores may offer useful insights that can assist health service delivery planning. An approach based on overall risk without adjustment of specific risk factors however, may underestimate treatment needs. At the individual level, the total risk approach offers important clinical benefits. However, countries need to develop appropriate clinical guidelines and operational guidance for detection and management of CVD risk using total CVD-risk approach at different levels of health system. Operational research is needed to assess implementation issues.
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spelling pubmed-36799762013-06-13 Assessment of total cardiovascular risk using WHO/ISH risk prediction charts in three low and middle income countries in Asia Otgontuya, Dugee Oum, Sophal Buckley, Brian S Bonita, Ruth BMC Public Health Research Article BACKGROUND: Recent research has used cardiovascular risk scores intended to estimate “total cardiovascular disease (CVD) risk” in individuals to assess the distribution of risk within populations. The research suggested that the adoption of the total risk approach, in comparison to treatment decisions being based on the level of a single risk factor, could lead to reductions in expenditure on preventive cardiovascular drug treatment in low- and middle-income countries. So that the patient benefit associated with savings is highlighted. METHODS: This study used data from national STEPS surveys (STEPwise Approach to Surveillance) conducted between 2005 and 2010 in Cambodia, Malaysia and Mongolia of men and women aged 40–64 years. The study compared the differences and implications of various approaches to risk estimation at a population level using the World Health Organization/International Society of Hypertension (WHO/ISH) risk score charts. To aid interpretation and adjustment of scores and inform treatment in individuals, the charts are accompanied by practice notes about risk factors not included in the risk score calculations. Total risk was calculated amongst the populations using the charts alone and also adjusted according to these notes. Prevalence of traditional single risk factors was also calculated. RESULTS: The prevalence of WHO/ISH “high CVD risk” (≥20% chance of developing a cardiovascular event over 10 years) of 6%, 2.3% and 1.3% in Mongolia, Malaysia and Cambodia, respectively, is in line with recent research when charts alone are used. However, these proportions rise to 33.3%, 20.8% and 10.4%, respectively when individuals with blood pressure > = 160/100 mm/Hg and/or hypertension medication are attributed to “high risk”. Of those at “moderate risk” (10- < 20% chance of developing a cardio vascular event over 10 years), 100%, 94.3% and 30.1%, respectively are affected by at least one risk-increasing factor. Of all individuals, 44.6%, 29.0% and 15.0% are affected by hypertension as a single risk factor (systolic ≥ 140 mmHg or diastolic ≥ 90 mmHg or medication). CONCLUSIONS: Used on a population level, cardiovascular risk scores may offer useful insights that can assist health service delivery planning. An approach based on overall risk without adjustment of specific risk factors however, may underestimate treatment needs. At the individual level, the total risk approach offers important clinical benefits. However, countries need to develop appropriate clinical guidelines and operational guidance for detection and management of CVD risk using total CVD-risk approach at different levels of health system. Operational research is needed to assess implementation issues. BioMed Central 2013-06-05 /pmc/articles/PMC3679976/ /pubmed/23734670 http://dx.doi.org/10.1186/1471-2458-13-539 Text en Copyright © 2013 Otgontuya et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Otgontuya, Dugee
Oum, Sophal
Buckley, Brian S
Bonita, Ruth
Assessment of total cardiovascular risk using WHO/ISH risk prediction charts in three low and middle income countries in Asia
title Assessment of total cardiovascular risk using WHO/ISH risk prediction charts in three low and middle income countries in Asia
title_full Assessment of total cardiovascular risk using WHO/ISH risk prediction charts in three low and middle income countries in Asia
title_fullStr Assessment of total cardiovascular risk using WHO/ISH risk prediction charts in three low and middle income countries in Asia
title_full_unstemmed Assessment of total cardiovascular risk using WHO/ISH risk prediction charts in three low and middle income countries in Asia
title_short Assessment of total cardiovascular risk using WHO/ISH risk prediction charts in three low and middle income countries in Asia
title_sort assessment of total cardiovascular risk using who/ish risk prediction charts in three low and middle income countries in asia
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3679976/
https://www.ncbi.nlm.nih.gov/pubmed/23734670
http://dx.doi.org/10.1186/1471-2458-13-539
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