Comparison Between ASCVD Versus WHO Risk Score in Predicting of 10-Year Cardiovascular Risk in an Iranian Adult: A Hospital-Based Cross-Sectional Study
Cardiovascular disease (CVD) mortality has increased in the Iranian population. Word Health Organization (WHO) risk score was recently used in Iranian prevention and control of non-communicable disease programs for risk assessment. The purpose of the study was to compare the 10-year cardiovascular risk using atherosclerotic cardiovascular disease (ASCVD) and WHO risk score. In a cross-sectional study, data from patients with cardiac symptoms without any documents related to CVD were collected from the outpatient clinic. The proportion of subjects with high CVD risk according to ASCVD and WHO risk score and also agreement between two scores was presented. The sensitivity and specificity of ASCVD according to the WHO risk score as a national risk assessment tool were calculated. The study included 284 subjects with a mean age of 53.80 (8.78) years and 68 % of women. The frequency of subjects with high CVD risk based on ASCVD and WHO was 35% and 6%, respectively. The agreement between the two scores was moderate (κ=0.45), with the most agreement in identifying low-risk subjects. The sensitivity and specificity of ASCVD according to the WHO risk score was 95.3% and 75.1%, respectively. The present finding showed that Agreement between two risk scores was moderated, especially in stratifying low-risk subjects. But, the ASCVD risk score categorized more people as a high risk rather than the WHO tool. Assessment of the accuracy of the WHO risk score with comparing predicted risk with observed risk in a cohort study for the Iranian population is necessary.
2. Fahimfar N, Khalili D, Sepanlou SG, Malekzadeh R, Azizi F, Mansournia MA, et al. Cardiovascular mortality in a Western Asian country: results from the Iran Cohort Consortium. BMJ Open 2018;8:e020303.
3. Meysamie A, Salarvand F, Khorasanizadeh M, Ghalehtaki R, Eskian M, Ghodsi S, et al. Cardiovascular risk assessment by FRS and SCORE in Iranian adult population. J Diabetes Metab Disord 2017;16:35.
4. Eslami A, Mozaffary A, Derakhshan A, Azizi F, Khalili D, Hadaegh F. Sex-specific incidence rates and risk factors of premature cardiovascular disease. A long term follow up of the Tehran Lipid and Glucose Study. Int J Cardiol 2017;227:826-32.
5. Otgontuya D, Oum S, Buckley BS, Bonita R. Assessment of total cardiovascular risk using WHO/ISH risk prediction charts in three low and middle income countries in Asia. BMC Public Health 2013;13:539.
6. DeFilippis AP, Young R, McEvoy JW, Michos ED, Sandfort V, Kronmal RA, et al. Risk score overestimation: the impact of individual cardiovascular risk factors and preventive therapies on the performance of the American Heart Association-American College of Cardiology-Atherosclerotic Cardiovascular Disease risk score in a modern multi-ethnic cohort. Eur Heart J 2016;38:598-608.
7. Goff DC, Lloyd-Jones DM, Bennett G, Coady S, D’Agostino RB, Gibbons R, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014;63:2935-59.
8. WHO. Education MoHaM. Package of essential noncommunicable (PEN) disease intervention for primary health care. (Accessed at https://www.who.int/nmh/publications/essential_ncd_interventions_lr_settings.pdf.)
9. Mendis S, Lindholm LH, Anderson SG, Alwan A, Koju R, Onwubere BJ, et al. Total cardiovascular risk approach to improve efficiency of cardiovascular prevention in resource constrain settings. J Clin Epidemiol 2011;64:1451-62.
10. Selvarajah S, Kaur G, Haniff J, Cheong KC, Hiong TG, van der Graaf Y, et al. Comparison of the Framingham Risk Score, SCORE and WHO/ISH cardiovascular risk prediction models in an Asian population. Int J Cardiol 2014;176:211-8.
11. Tulloch-Reid MK, Younger NO, Ferguson TS, Francis DK, Abdulkadri AO, Gordon-Strachan GM, et al. Excess cardiovascular risk burden in Jamaican women does not influence predicted 10-year CVD risk profiles of Jamaica adults: an analysis of the 2007/08 Jamaica Health and Lifestyle Survey. PLoS One 2013;8:e66625.
12. Nordet P, Mendis S, Dueñas A, de la Noval R, Armas N, de la Noval IL, et al. Total cardiovascular risk assessment and management using two prediction tools, with and without blood cholesterol. MEDICC Rev 2013;15:36-40.
13. Albarqouni L, Doust JA, Magliano D, Barr EL, Shaw JE, Glasziou PP. External validation and comparison of four cardiovascular risk prediction models with data from the Australian Diabetes, Obesity and Lifestyle study. Med J Aust 2019;210:161-7.
14. Chia YC, Lim HM, Ching SM. Validation of the pooled cohort risk score in an Asian population–a retrospective cohort study. BMC Cardiovasc Disord 2014;14:163.
15. Mancia G. Blood pressure reduction and cardiovascular outcomes: past, present, and future. Am J Cardiol 2007;100:S3-9.
16. Yu PC, Bosnyak Z, Ceriello A. The importance of glycated haemoglobin (HbA1c) and postprandial glucose (PPG) control on cardiovascular outcomes in patients with type 2 diabetes. Diabetes Res Clin Pract 2010;89:1-9.
17. Stein EA, Raal FJ. Targeting LDL: is lower better and is it safe? Best Pract Res Clin Endocrinol Metab 2014;28:309-24.
18. Roth GA, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018;392:1736-88.
19. Khalili D, Hadaegh F, Soori H, Steyerberg EW, Bozorgmanesh M, Azizi F. Clinical usefulness of the Framingham cardiovascular risk profile beyond its statistical performance: the Tehran Lipid and Glucose Study. Am J Epidemiol 2012;176:177-86.
20. Dent T. Predicting the risk of coronary heart disease: I. The use of conventional risk markers. Atherosclerosis 2010;213:345-51.
|Issue||Vol 60 , No 1 (2022)|
|Cardiovascular disease Risk assessment Risk|
|Rights and permissions|
|This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.|