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Original Research

Comparison of Nonblood-Based and Blood-Based Total CV Risk Scores in Global Populations

Authors:

Thomas A. Gaziano ,

Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA; Center for Health Decision Science, Harvard T.H. Chan School of Public Boston, MA, US
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Shafika Abrahams-Gessel,

Center for Health Decision Science, Harvard T.H. Chan School of Public Boston, MA, US
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Sartaj Alam,

Center for Health Decision Science, Harvard T.H. Chan School of Public Boston, MA, US
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Dewan Alam,

Centre for Global Health Research, St. Michael's Hospital, Toronto, Ontario, CA
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Mohammed Ali,

Centre for Chronic Disease Control, Gurgaon, IN
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Gerald Bloomfield,

Duke Clinical Research Institute, Durham, NC, US
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Rodrigo M. Carrillo-Larco,

CRONICAS Center of Excellence for Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, PE
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Dorairaj Prabhakaran,

Centre for Chronic Disease Control, Gurgaon; Public Health Foundation of India, Gurgaon, IN
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Laura Gutierrez,

Institute for Clinical Effectiveness and Health Policy, Buenos Aires, AR
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Vilma Irazola,

Institute for Clinical Effectiveness and Health Policy, Buenos Aires, AR
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Naomi S. Levitt,

Chronic Disease Initiative for Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town; Division of Diabetic Medicine and Endocrinology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, ZA
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J. Jaime Miranda,

CRONICAS Center of Excellence for Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima; Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, PE
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Antonio Bernabe-Ortiz,

CRONICAS Center of Excellence for Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, PE
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Ankur Pandya,

Center for Health Decision Science, Harvard T.H. Chan School of Public Boston, MA, US
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Adolfo Rubinstein,

Institute for Clinical Effectiveness and Health Policy, Buenos Aires, AR
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Krisela Steyn,

Chronic Disease Initiative for Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, ZA
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Denis Xavier,

St. John’s Medical College and Research Institute, St. John’s National Academy of Health Sciences, Bangalore, IN
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Lijing L. Yan

The George Institute for Global Health at Peking University Health Science Center, Beijing; Duke Global Health Institute, Global Health Research Center, Duke Kunshan University, Kunshan, CN
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Abstract

Background: Cost-effective primary prevention of cardiovascular disease (CVD) in low- and middle-income countries requires accurate risk assessment. Laboratory-based risk tools currently used in high-income countries are relatively expensive and impractical in many settings due to lack of facilities.

Objectives: This study sought to assess the correlation between a non-laboratory-based risk tool and 4 commonly used, laboratory-based risk scores in 7 countries representing nearly one-half of the world’s population.

Methods: We calculated 10-year CVD risk scores for 47,466 persons with cross-sectional data collected from 16 different cohorts in 9 countries. The performance of the non-laboratory-based risk score was compared with 4 laboratory-based risk scores: Pooled Cohort Risk Equations (ASCVD [Atherosclerotic Cardiovascular Disease]), Framingham, and SCORE (Systematic Coronary Risk Evaluation) for high- and low-risk countries. Rankings of each score were compared using Spearman rank correlations. Based on these correlations, we measured concordance between individual absolute CVD risk as measured by the Harvard NHANES (National Health and Nutrition Examination Survey) risk score, and the 4 laboratory-based risk scores, using both the conventional Framingham risk thresholds of >20% and the recent ASCVD guideline threshold of >7.5%.

Results: The aggregate Spearman rank correlations between the non-laboratory-based risk score and the laboratory-based scores ranged from 0.915 to 0.979 for women and from 0.923 to 0.970 for men. When applying the conventional Framingham risk threshold of >20% over 10 years, 92.7% to 96.0% of women and 88.3% to 92.8% of men were equivalently characterized as “high” or “low” risk. Applying the recent ASCVD guidelines risk threshold of >7.5% resulted in risk characterization agreement for women ranging from 88.1% to 94.4% and from 89.0% to 93.7% for men.

Conclusions: The correlation between non-laboratory-based and laboratory-based risk scores is very high for both men and women. Potentially large numbers of high-risk individuals could be detected with relatively simple tools.

Highlights

  • Non-laboratory-based risk scores can equivalently characterize cardiovascular risk.
  • Correlation between laboratory-based and non-laboratory-based risk scores is very high.
  • The non-laboratory-based score classified up to 25% of subjects with >20% 10 years risk of cardiovascular disease over 10 years.
How to Cite: Gaziano TA, Abrahams-Gessel S, Alam S, Alam D, Ali M, Bloomfield G, et al.. Comparison of Nonblood-Based and Blood-Based Total CV Risk Scores in Global Populations. Global Heart. 2016;11(1):37–46. DOI: http://doi.org/10.1016/j.gheart.2015.12.003
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Published on 01 Mar 2016.
Peer Reviewed

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