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Performance of the non-laboratory based 2019 WHO cardiovascular disease risk prediction chart in Eastern Sub-Saharan
Anderson Bendera1, Keiko Nakamura1, Kaoruko Seino1
1Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, Japan.
Insights
The updated non-lab-based cardiovascular disease (CVD) risk chart is suitable for general populations without diabetes in Eastern Sub-Saharan Africa. However, lab-based estimation is recommended for individuals with diabetes to prevent underestimation of CVD risk.
Area of Science:
- Public Health
- Epidemiology
- Cardiovascular Disease Research
Background:
- The World Health Organization (WHO) released updated cardiovascular disease (CVD) risk prediction charts in 2019, covering 21 global regions.
- Accurate CVD risk assessment is crucial for public health interventions, especially in regions with limited resources.
Purpose of the Study:
- To evaluate the performance of an updated WHO non-lab-based CVD risk prediction chart.
- To compare its accuracy against a lab-based chart in Eastern Sub-Saharan Africa.
- To assess performance across different glucose tolerance statuses: normoglycaemia, impaired fasting glucose (IFG), and diabetes.
Main Methods:
- Utilized data from six WHO STEPS surveys in Eastern Sub-Saharan Africa (2012-2017).
- Included 9857 participants aged 40-69 years with no prior CVD history.
- Assessed agreement between non-lab-based and lab-based charts using Bland-Altman plots and Cohen's kappa.
Main Results:
- Pooled median 10-year CVD risk was 3% for both chart types.
- The non-lab-based chart underestimated CVD risk in 57.6% of individuals with diabetes.
- Concordance was high (91.3%), but agreement varied by glucose status (Kappa: 0.79 normoglycaemia, 0.78 IFG, 0.43 diabetes).
Conclusions:
- The non-lab-based chart is appropriate for CVD risk estimation in the general population without diabetes in this region.
- Lab-based risk assessment is essential for individuals with diabetes to ensure accurate CVD risk evaluation.
- These findings support resource-conscious CVD risk stratification strategies.
Background And Aims:
The World Health Organization (WHO) updated its cardiovascular disease (CVD) risk prediction charts in 2019 to cover 21 global regions. We aimed to assess the performance of an updated non-lab-based risk chart for people with normoglycaemia, impaired fasting glucose (IFG), and diabetes in Eastern Sub-Saharan Africa.
Methods And Results:
We used data from six WHO STEPS surveys conducted in Eastern Sub-Saharan Africa between 2012 and 2017. We included 9857 participants aged 40-69 years with no CVD history. The agreement between lab- and non-lab-based charts was assessed using Bland-Altman plots and Cohen's kappa. The median age of the participants was 50 years (25-75th percentile: 44-57). The pooled median 10-year CVD risk was 3 % (25-75th percentile: 2-5) using either chart. According to the estimation, 7.5 % and 8.4 % of the participants showed an estimated CVD risk ≥10 % using the non-lab-based chart or the lab-based chart, respectively. The concordance between the two charts was 91.3 %. The non-lab-based chart underestimated the CVD risk in 57.6 % of people with diabetes. In the Bland-Altman plots, the limits of agreement between the two charts were widest among people with diabetes (-0.57-7.54) compared to IFG (-1.75-1.22) and normoglycaemia (-1.74-1.06). Kappa values of 0.79 (substantial agreement), 0.78 (substantial agreement), and 0.43 (moderate agreement) were obtained among people with normoglycaemia, IFG, and diabetes, respectively.
Conclusions:
Given limited healthcare resources, the updated non-lab-based chart is suitable for CVD risk estimation in the general population without diabetes. Lab-based risk estimation is suitable for individuals with diabetes to avoid risk underestimation.
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