WHO Non-Lab-Based CVD Risk Assessment: A Reliable Measure in a North Indian Population
P Ananda Selva Das1,2, Mahasweta Dubey1,3, Ravneet Kaur1,4
1Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India.
Insights
This study found that World Health Organization (WHO) non-laboratory cardiovascular disease (CVD) risk charts accurately estimate CVD risk in rural India. These charts are suitable for resource-limited settings, aiding timely interventions.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Cardiovascular diseases (CVD) pose a significant health burden globally.
- Timely interventions for high-risk individuals, including those with high total CVD risk, can reduce heart attack and stroke incidence.
- Accurate CVD risk prediction is crucial for identifying individuals who would benefit most from preventive strategies.
Purpose of the Study:
- To determine the concordance between laboratory-based and non-laboratory-based World Health Organization (WHO) CVD risk charts.
- To estimate the prevalence of key CVD risk factors in a rural Indian population.
- To assess the suitability of non-laboratory CVD risk charts for resource-limited settings.
Main Methods:
- A community-based cross-sectional study involving 1,018 participants aged 30-69 years in rural Ballabgarh, Haryana, India.
- Data collection included the WHO STEPS questionnaire, anthropometry, and laboratory investigations for CVD risk factors.
- Concordance analysis, including kappa statistics, was performed between laboratory and non-laboratory WHO CVD risk charts.
Main Results:
- Hypertension (39.4%), overweight (34.1%), current smoking (23.6%), and hypercholesterolemia (18.7%) were prevalent CVD risk factors.
- The agreement between laboratory- and non-laboratory-based charts was 83.3% (kappa = 0.64).
- Non-laboratory charts demonstrated good sensitivity (86.5%) and specificity (90.3%) at a 5% risk cut-off compared to laboratory-based charts.
Conclusions:
- There is good agreement between laboratory-based and non-laboratory-based WHO CVD risk charts.
- Non-laboratory-based risk charts are suitable for estimating CVD risk in resource-limited settings like rural India.
- These findings support the use of simplified risk assessment tools for CVD prevention in underserved populations.
Introduction:
Timely, affordable, and sustained interventions reduce the risk of heart attack or Stroke in people with a high total risk of cardiovascular diseases (CVD). Risk prediction tools are available to estimate the cardiovascular risk using information on multiple variables. CVD risk charts prepared by the World Health Organization (WHO) has laboratory-based and non-laboratory-based charts with the latter meant for use in resource limited settings. We conducted a study to determine concordance between the laboratory- and non-laboratory risk charts and to estimate the prevalence of selected CVD risk factors in a rural Indian population.
Methods:
A community-based cross-sectional study was conducted in rural area of Ballabgarh in district Faridabad, Haryana. Sample of 1,018 participants aged 30-69 years was selected randomly from study area. Information on CVDs risk factors was obtained using WHO STEPS questionnaire, anthropometry and laboratory investigation. Risk distribution among the study participants was observed. Concordance between laboratory- and non-laboratory-based WHO CVD risk charts was determined using agreement analysis.
Results:
The mean age of the study participants was 43.9 (8.9) years and 55.6% participants were women. Among various CVD risk factors, hypertension (39.4%) was the major factor followed by overweight (34.1%) was found to be major factor, followed by current smoking (23.6%) and hypercholesterolemia (18.7%). The concordance between the two charts was 83.3% with kappa value of 0.64. Considering laboratory-based charts as the gold standard, the sensitivity and specificity of non-laboratory-based risk charts at 5% risk as cut-off was 86.5% and 90.3% respectively.
Conclusion:
The study shows a good agreement between the laboratory-based and non-laboratory-based risk charts. Thus non-laboratory-based risk charts are suitable for risk estimation of CVDs for use in resource limited settings like India.
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