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Recalibration of Framingham risk for a local population of Sri Lanka
Sameera Upashantha Ranasinghe1, E M D S Ekanayake2, Laksitha Iroshan Ranasinghe3
1Ministry of Health, Nutrition and Indigenous Medicine, Colombo, Sri Lanka. rasu.ranasinghe@gmail.com.
Insights
Recalibrating the Framingham cardiovascular disease (CVD) risk equation for Sri Lanka
Area of Science:
- Cardiovascular disease epidemiology
- Public health research
- Health risk assessment
Background:
- Cardiovascular Diseases (CVD) are a leading cause of death and disability globally and in Sri Lanka.
- Accurate CVD risk prediction is crucial for cost-effective prevention, especially in resource-limited settings.
- Existing risk models may not accurately reflect local risk factor distributions within Sri Lanka.
Purpose of the Study:
- To recalibrate the Framingham cardiovascular disease (CVD) risk equation.
- To adapt the CVD risk assessment tool to the local risk factor profile of the Kurunegala region in Sri Lanka.
Main Methods:
- A cross-sectional study involving 1,102 participants from the Kurunegala region.
- Data collection via interviewer-administered questionnaires, anthropometric, blood pressure, and biochemical measurements.
- Estimation of CVD risk using original and recalibrated Framingham equations, incorporating local mortality and morbidity data.
Main Results:
- The original Framingham equation over-predicted CVD risk in the study population.
- Recalibration adjusted risk predictions, with significant shifts in the proportion of individuals categorized with low (<10%) and high (>40%) CVD risk.
- Original scores predicted 55.5% with <10% risk vs. 62.3% with recalibrated scores; 2.2% with >40% risk vs. 1.8% with recalibrated scores.
Conclusions:
- The findings highlight the necessity of developing region-specific CVD risk prediction tools for Sri Lanka.
- Using a locally recalibrated tool can prevent over-treatment and unnecessary healthcare expenditure.
- Implementing localized risk assessment improves the efficiency of CVD prevention strategies.
Background:
Cardiovascular Diseases (CVD) account for the highest number of deaths and disability globally and within Sri Lanka. A CVD risk prediction tool is a simple means of early identification of high-risk groups which is a cost-effective preventive strategy, especially for resource-poor countries. Distribution of risk factor levels varies in different regions even within the same country, thus a common risk estimation tool for the country may give false local predictions. Since there are few published data related to Sri Lanka the aim of this study was to recalibrate the Framingham equation according to the local risk factor profile of a population in the Kurunegala region in Sri Lanka.
Method:
A cross-sectional study was conducted with the participation of 1 102 persons from the Kurunegala Regional Director of Health Services area and the data was collected using an interviewer-administered questionnaire, anthropometric, blood pressure, and biochemical measurements. CVD risk was estimated using Framingham original and recalibrated CVD risk assessment methods. Current CVD mortality and morbidity data and the recalibration method conducted by the method described by Wilson and colleagues were used for calculations.
Results:
Original and recalibrated Framingham CVD risk scores predicted 55.5% (N = 612) and 62.3% (N = 687) to be having less than 10% CVD risk respectively. Further, the original and recalibrated CVD Risk Scores predicted 2.2% (N = 24) and 1.8% (N = 20) to be having CVD risk more than 40% respectively.
Conclusion:
These findings show an over prediction of the CVD risk with the original Framingham risk calculations which signifies the importance of development of a region-specific risk prediction tool using local risk factor data in Sri Lanka which will prevent unnecessary expenditure to manage people without risk of CVD.
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