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Title: Comparative assessment of absolute cardiovascular disease risk characterization from non-laboratory- based risk assessment in South African populations
Authors: 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 Prakash 
Prakaschandra, Dorcas Rosaley 
Laubscher, Ria 
Issue Date: 24-Jul-2013
Publisher: BioMed Central
Source: Gaziano, T.A., Pandya, A., Steyn, K., Levitt, N., Mollentze, W., Joubert, G., Walsh, C.M.,,Motala, A.A., Kruger, A., Schutte, A.E.; Naidoo, D.P.; Prakaschandra, D.R. and Laubscher, R. 2013. Comparative assessment of absolute cardiovascular disease risk characterization from non-laboratory- based risk assessment in South African populations. BMC Medicine, 11(170).

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.

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.

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.

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.
DOI: 10.1186/1741-7015-11-170
Appears in Collections:Research Publications (Health Sciences)

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