Researchers have produced the first set of risk charts to help clinicians predict future fatal and non-fatal cardiovascular disease (CVD) events, including heart attack and stroke, which take into account the limited availability of facilities to do bloodwork in low- and middle-income countries.
The complete set of new risk charts and the risk calculators, which apply to 182 countries, are available online at globorisk.org
“National and international guidelines recommend that physicians use risk prediction equations, usually in the form of risk charts, to predict which of their patients are at high risk for heart disease and stroke, and to suggest lifestyle modification or prescribe medication to lower their risk."
CVD leading cause of death
These new risk charts, specifically calibrated for each country, remove major obstacles in applying risk-based strategies to prevent cardiovascular diseases,” said Goodarz Danaei, assistant professor of global health at Harvard Chan School and senior author of the paper.
Cardiovascular diseases are the leading cause of death and disability worldwide, and more than three-quarters of CVD-related deaths occur in low- and middle-income countries.
But identifying those at high risk of having a future cardiovascular event can be difficult in many countries because there are no reliable risk charts, and because calculating risk typically relies on measurements of blood sugar and lipids - which, in resource-poor settings, can make the assessment too costly or impractical.
Geared towards each country
These up-to-date charts will be useful everywhere, but particularly in low- and middle-income countries that lack locally-developed models to predict CVD risk, and in places where access to labs that can perform bloodwork is limited. Typically, blood tests are necessary to measure CVD risk factors such as blood sugar and lipids.
The researchers set out to provide CVD risk prediction models geared toward each country. They developed two models: one that uses lab-based blood measurements, and one that can be used in the absence of bloodwork (office-based model). To generate the models, researchers used data from eight long-term studies in the US and recalibrated the models by using data on CVD risk factor levels and CVD rates for each target country.
The study found that, between 85% and 99% of the time, the office-based risk prediction model worked as well as the laboratory-based model in characterising CVD risk. However, among diabetes patients, the office-based model underestimated the risk noticeably.
The study also found that 10-year CVD risk was lower in high-income countries than in lower- and middle-income countries. The highest CVD risks were in countries in Central and Southeast Asia and in Eastern Europe. CVD risk also varied significantly across countries and across genders. For example, the proportion of people in high-income countries at high risk for CVD ranged from 1% for South Korean women to 42% for Czech men, and in low- and middle-income countries it ranged from 2% in Uganda for both men and women to 13% in Iranian men.