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Ambiguity about Selection of Cardiovascular Risk Stratification Tools: Evidence from a North Indian Rural Population

Tarundeep Singh1, Manju Pilania2, Gopal Singh Jat1

  • 1Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Indian Journal of Community Medicine : Official Publication of Indian Association of Preventive & Social Medicine
|October 9, 2018
PubMed

Insights

Cardiovascular disease (CVD) risk scores from WHO/ISH and Framingham Risk Score (FRS) showed good agreement in India. However, significant differences in high-risk predictions highlight the need for local validation of CVD risk tools.

Area of Science:

  • Cardiology
  • Public Health
  • Epidemiology

Background:

  • Non-laboratory cardiovascular disease (CVD) risk scoring tools are crucial for resource-limited settings.
  • Performance of existing CVD risk tools needs validation in diverse populations, specifically the Indian population.
  • This study evaluates the World Health Organization (WHO)/International Society for Hypertension (ISH) risk prediction chart and the Framingham Risk Score (FRS) calculator in an Indian context.

Purpose of the Study:

  • To assess and compare the performance of the WHO/ISH risk prediction chart and the FRS calculator for 10-year cardiovascular event risk in an Indian population.
  • To determine the agreement between these two widely used, non-laboratory based CVD risk assessment tools.
  • To inform the judicious use of resources in Indian healthcare settings for CVD risk stratification.

Main Methods:

  • A cross-sectional study involving 283 participants aged 30-74 years in rural Punjab, India.
  • Utilized the non-laboratory based WHO/ISH risk prediction chart (South-East Asia Region) and the FRS calculator to estimate 10-year CVD risk.
  • Employed Chi-square test for trend and quadratic weighted kappa for statistical analysis of agreement.

Main Results:

  • The study included 67.1% females with a mean age of 52.1 years.
  • WHO/ISH identified 11.3% high and 4.9% very high CVD risk, while FRS predicted 13.8% high and 12.0% very high risk.
  • A good level of agreement (67.8%) was observed between the WHO/ISH chart and the FRS calculator.

Conclusions:

  • Despite good overall agreement, significant discrepancies exist in the proportion of individuals classified as high or very high risk by the WHO/ISH chart and FRS calculator.
  • The findings underscore the necessity of validating CVD risk prediction tools for the local Indian population.
  • Prospective cohort studies are recommended to ensure accurate and resource-efficient CVD risk assessment in India.
Abstract

Keywords:
Cardiovascular diseaseshealth resourcesprimary carerisk

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