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The Significance of the WHO/ISH Absolute Cardiovascular Risk Prediction Scores among Recent Stroke Survivors in
Ansumana S Bockarie1, Nana Kwame Ayisi-Boateng2, Samuel Blay Nguah2
1University of Cape Coast.
Insights
The World Health Organization/International Society of Hypertension (WHO/ISH) risk score may underestimate cardiovascular disease risk in West African stroke survivors. Further validation is needed for this population to ensure effective secondary prevention strategies.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Atherosclerotic cardiovascular disease is the primary cause of stroke globally.
- The World Health Organization/International Society of Hypertension (WHO/ISH) risk score aims to provide regionally specific atherosclerotic cardiovascular disease risk assessment.
- No prior studies have evaluated absolute cardiovascular risk scores using the WHO/ISH tool in West African stroke survivors.
Purpose of the Study:
- To assess absolute cardiovascular disease (CVD) risk among recent stroke survivors in West Africa using the WHO/ISH risk score.
- To compare CVD risk categories based on the WHO/ISH score with demographic, clinical, and vascular risk profiles.
- To investigate the association between WHO/ISH CVD risk and various patient characteristics.
Main Methods:
- Analysis of baseline data from 414 stroke survivors in the PINGS-2 clinical trial.
- Calculation and categorization of WHO/ISH risk scores (low, moderate, high/very high).
- Comparison of demographic, medical history, anthropometric, and vascular risk data across risk categories using multivariate logistic regression.
Main Results:
- The study population had a mean age of 58 years, with 56.5% males. Ischemic strokes (74.3%) were more prevalent than hemorrhagic strokes (22%).
- Over two-thirds (76.3%) of participants had a low (<10%) 10-year CVD risk, 14.5% had moderate risk, and 9.2% had high/very high risk.
- Absolute CVD risk was significantly associated with age, income, tobacco use, systolic blood pressure, and HbA1c. Stroke type did not significantly impact absolute CVD risk.
Conclusions:
- A lower proportion of Ghanaian stroke survivors were classified as high risk by the WHO/ISH score.
- The study questions the appropriateness of the WHO/ISH risk score for driving secondary prevention in this specific West African population.
- Further research is needed to validate cardiovascular risk assessment tools for stroke survivors in West Africa.
Background:
The leading cause of stroke remains atherosclerotic cardiovascular disease. The World Health Organization/International Society of Hypertension risk score represents an effort to produce a risk assessment tool for atherosclerotic cardiovascular disease that is regionally specific. No previous work has described absolute cardiovascular risk scores among recent stroke survivors in West Africa via this tool.
Methods:
A cross-sectional analysis of baseline data from the multicenter, phase III randomized, open-label, clinical trial, Phone-based Intervention under Nurse Guidance II (PINGS-2), was performed. Data from 414 participants who had recently survived a stroke and met the age range compatible with the risk estimation tool were analyzed. The WHO/ISH score was calculated for each participant and categorized into low, moderate, and high/very high CVD risk scores. Demographic data, medical histories, anthropometry, vascular risk profiles, stroke types and severity indices were compared across CVD risk categories. Multivariate logistic regression was performed to further examine variables significantly associated with WHO/ISH CVD risk via univariate analysis.
Results:
The mean age of the study population was 58 years (SD = 12), with the majority being male (56.5%). Ischemic strokes (n = 263, 74.3%) were more common than hemorrhagic strokes (n = 78, 22%). Over two-thirds (76.3%) of the participants were estimated to have a low (< 10%) risk of cardiovascular disease in the next 10 years, 14.5% were estimated to have a moderate risk, and only 9.2% were stratified as high or very high risk. The absolute CVD risk score was significantly associated with age, higher income, tobacco use, systolic blood pressure and HBA1c. There was no significant difference in absolute cardiovascular risk by stroke type.
Conclusion:
A comparatively lower proportion of Ghanaian stroke survivors were classified as high risk by the WHO/ISH risk score. This raises the question of its appropriateness as a cardiovascular risk assessment tool to drive secondary prevention among this patient population.
Trial Registration:
NCT04404166. Registered on May 27,2020 at ClinicalTrials.gov.
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