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

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 performa...

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Autores principales: Gaziano, Thomas A, Pandya, Ankur, Steyn, Krisela, Levitt, Naomi, Mollentze, Willie, Joubert, Gina, Walsh, Corinna M, Motala, Ayesha A, Kruger, Annamarie, Schutte, Aletta E, Naidoo, Datshana P, Prakaschandra, Dorcas R, Laubscher, Ria
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3734109/
https://www.ncbi.nlm.nih.gov/pubmed/23880010
http://dx.doi.org/10.1186/1741-7015-11-170
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author Gaziano, Thomas A
Pandya, Ankur
Steyn, Krisela
Levitt, Naomi
Mollentze, Willie
Joubert, Gina
Walsh, Corinna M
Motala, Ayesha A
Kruger, Annamarie
Schutte, Aletta E
Naidoo, Datshana P
Prakaschandra, Dorcas R
Laubscher, Ria
author_facet Gaziano, Thomas A
Pandya, Ankur
Steyn, Krisela
Levitt, Naomi
Mollentze, Willie
Joubert, Gina
Walsh, Corinna M
Motala, Ayesha A
Kruger, Annamarie
Schutte, Aletta E
Naidoo, Datshana P
Prakaschandra, Dorcas R
Laubscher, Ria
author_sort Gaziano, Thomas A
collection PubMed
description 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.
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spelling pubmed-37341092013-08-06 Comparative assessment of absolute cardiovascular disease risk characterization from non-laboratory-based risk assessment in South African populations Gaziano, Thomas A Pandya, Ankur Steyn, Krisela Levitt, Naomi Mollentze, Willie Joubert, Gina Walsh, Corinna M Motala, Ayesha A Kruger, Annamarie Schutte, Aletta E Naidoo, Datshana P Prakaschandra, Dorcas R Laubscher, Ria BMC Med Research Article 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. BioMed Central 2013-07-24 /pmc/articles/PMC3734109/ /pubmed/23880010 http://dx.doi.org/10.1186/1741-7015-11-170 Text en Copyright © 2013 Gaziano 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
Gaziano, Thomas A
Pandya, Ankur
Steyn, Krisela
Levitt, Naomi
Mollentze, Willie
Joubert, Gina
Walsh, Corinna M
Motala, Ayesha A
Kruger, Annamarie
Schutte, Aletta E
Naidoo, Datshana P
Prakaschandra, Dorcas R
Laubscher, Ria
Comparative assessment of absolute cardiovascular disease risk characterization from non-laboratory-based risk assessment in South African populations
title Comparative assessment of absolute cardiovascular disease risk characterization from non-laboratory-based risk assessment in South African populations
title_full Comparative assessment of absolute cardiovascular disease risk characterization from non-laboratory-based risk assessment in South African populations
title_fullStr Comparative assessment of absolute cardiovascular disease risk characterization from non-laboratory-based risk assessment in South African populations
title_full_unstemmed Comparative assessment of absolute cardiovascular disease risk characterization from non-laboratory-based risk assessment in South African populations
title_short Comparative assessment of absolute cardiovascular disease risk characterization from non-laboratory-based risk assessment in South African populations
title_sort comparative assessment of absolute cardiovascular disease risk characterization from non-laboratory-based risk assessment in south african populations
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3734109/
https://www.ncbi.nlm.nih.gov/pubmed/23880010
http://dx.doi.org/10.1186/1741-7015-11-170
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