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Comparison of Nonblood-Based and Blood-Based Total CV Risk Scores in Global Populations
Thomas A Gaziano1, Shafika Abrahams-Gessel2, Sartaj Alam2
1Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA; Center for Health Decision Science, Harvard T.H. Chan School of Public Boston, MA, USA.
Insights
A simple, non-laboratory cardiovascular disease (CVD) risk tool shows high correlation with established laboratory-based scores. This finding suggests simpler methods can effectively identify high-risk individuals for primary prevention in diverse global settings.
Area of Science:
- Global Health
- Epidemiology
- Preventive Cardiology
Background:
- Cardiovascular disease (CVD) prevention in low- and middle-income countries (LMICs) necessitates cost-effective risk assessment.
- Existing laboratory-based risk tools are often impractical in LMICs due to cost and facility limitations.
Purpose of the Study:
- To evaluate the correlation between a non-laboratory risk assessment tool and four standard laboratory-based risk scores.
- To assess the performance of the non-laboratory tool across diverse populations in seven countries.
Main Methods:
- Cross-sectional analysis of 47,466 individuals from 16 cohorts in 9 countries.
- Comparison of a non-laboratory risk score against Pooled Cohort Equations (ASCVD), Framingham, and SCORE risk scores using Spearman rank correlations.
- Assessment of risk stratification concordance using Framingham (>20%) and ASCVD (>7.5%) thresholds.
Main Results:
- High Spearman rank correlations (0.915–0.979 for women, 0.923–0.970 for men) were observed between the non-laboratory and laboratory-based scores.
- Excellent agreement in risk categorization (>20% Framingham threshold) was found: 92.7–96.0% for women and 88.3–92.8% for men.
- High agreement (88.1–94.4% for women, 89.0–93.7% for men) was also achieved using the ASCVD >7.5% threshold.
Conclusions:
- Non-laboratory-based cardiovascular risk scores demonstrate a very high correlation with established laboratory-based methods.
- Simple, accessible risk assessment tools can effectively identify substantial numbers of individuals at high risk for cardiovascular disease, facilitating primary prevention efforts globally.
Background:
Cost-effective primary prevention of cardiovascular disease (CVD) in low- and middle-income countries requires accurate risk assessment. Laboratory-based risk tools currently used in high-income countries are relatively expensive and impractical in many settings due to lack of facilities.
Objectives:
This study sought to assess the correlation between a non-laboratory-based risk tool and 4 commonly used, laboratory-based risk scores in 7 countries representing nearly one-half of the world's population.
Methods:
We calculated 10-year CVD risk scores for 47,466 persons with cross-sectional data collected from 16 different cohorts in 9 countries. The performance of the non-laboratory-based risk score was compared with 4 laboratory-based risk scores: Pooled Cohort Risk Equations (ASCVD [Atherosclerotic Cardiovascular Disease]), Framingham, and SCORE (Systematic Coronary Risk Evaluation) for high- and low-risk countries. Rankings of each score were compared using Spearman rank correlations. Based on these correlations, we measured concordance between individual absolute CVD risk as measured by the Harvard NHANES (National Health and Nutrition Examination Survey) risk score, and the 4 laboratory-based risk scores, using both the conventional Framingham risk thresholds of >20% and the recent ASCVD guideline threshold of >7.5%.
Results:
The aggregate Spearman rank correlations between the non-laboratory-based risk score and the laboratory-based scores ranged from 0.915 to 0.979 for women and from 0.923 to 0.970 for men. When applying the conventional Framingham risk threshold of >20% over 10 years, 92.7% to 96.0% of women and 88.3% to 92.8% of men were equivalently characterized as "high" or "low" risk. Applying the recent ASCVD guidelines risk threshold of >7.5% resulted in risk characterization agreement for women ranging from 88.1% to 94.4% and from 89.0% to 93.7% for men.
Conclusions:
The correlation between non-laboratory-based and laboratory-based risk scores is very high for both men and women. Potentially large numbers of high-risk individuals could be detected with relatively simple tools.
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