Cardiovascular Risk Assessment Among Urban Population of Bangladesh Using WHO/ISH Risk Prediction Chart.

Ahmed, Madiha; Moniruzzaman, Mohammad; Chowdhury, Shahanaz; Banik, Palash Chandra

doi:10.1093/ije/dyv096.327

Cited by 4 publications

(4 citation statements)

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“…Studies conducted specifically among urban dwellers in LMIC countries such as Malaysia22 and Sri Lanka23 have found 20.5% and 8.2% individuals were at high risk (≥20%) of having a future CVD event, respectively. Furthermore, the proportion of individuals in our study shown to be at low risk of a CVD event over 10 years (<10% risk) was higher than that of studies who used the WHO/ISH risk prediction charts carried out in rural Nepal (86.4%),24 rural South India (83%)25 and rural Bangladesh (81.3%) 26. Mendis et al reported total 10 year CVD risk in defined geographical areas of seven countries including both urban and rural populations, but only two countries had a higher percentage of individuals classified as low risk in comparison to our study (lower: Iran (93.9%), Cuba (89.7%), Nigeria (86.0%), Georgia (83.1%), Pakistan (79.2%); similar: China (96.1%) and Sri Lanka (94.9%)) 12.…”

Section: Discussioncontrasting

confidence: 69%

Assessment of cardiovascular risk in a slum population in Kenya: use of World Health Organisation/International Society of Hypertension (WHO/ISH) risk prediction charts - secondary analyses of a household survey

et al. 2019

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ObjectivesAlthough cardiovascular disease (CVD) is of growing importance in low- and middle-income countries (LMICs), there are conflicting views regarding CVD as a major public health problem for the urban poor, including those living in slums. We examine multivariable risk prediction in a slum population and assess the number of cardiovascular related deaths within 10 years of application of the tool.SettingWe use data from the Nairobi Urban Health and Demographic Surveillance System (NUHDSS) population (residents of two slum communities) between May 2008 and April 2009.DesignThis is a secondary data analysis from a cross-sectional survey. We use the WHO/International Society of Hypertension (WHO/ISH) cardiovascular risk prediction tool to examine 10-year risk of major CVD events in a slum population. CVD deaths in the cohort, reported up until June 2018 and identified through verbal autopsy are also presented.Participants3063 men and women aged over 40 years with complete data for variables needed for the WHO/ISH risk prediction tool were eligible to take part.ResultsThe majority of study members (2895, 94.5%) were predicted to have ‘low’ risk (<10%) of a cardiovascular event over the next 10 years and just 51 (1.7%) to have ‘high’ CVD risk (≥20%). 91 CVD deaths were reported for the cohort up until June 2018. Of individuals classified as low risk, 74 (2.6%) were identified as having died of CVD. Nine (7.7%) individuals classified at 10% to 20% risk and eight (15.9%) classified at >20% were identified as dying of CVD.ConclusionsThis study shows that there is a low risk profile of CVD in this slum population in Nairobi, Kenya, in comparison to results from application of multivariable risk prediction tools in other LMIC populations. This has implications for health service planning in these contexts.

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Section: Discussioncontrasting

confidence: 69%

Assessment of cardiovascular risk in a slum population in Kenya: use of World Health Organisation/International Society of Hypertension (WHO/ISH) risk prediction charts - secondary analyses of a household survey

et al. 2019

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“…Three studies in Bangladesh reported CVD risk in adults. [18][19][20] Two of them were done in rural populations. The proportion of people who had high risk (≥20%) varied largely from 2.1% 19 to 10.0% 20 between two studies.…”

Section: Discussionmentioning

confidence: 99%

Estimated total cardiovascular risk in a rural area of Bangladesh: a household level cross-sectional survey done by local community health workers

et al. 2021

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ObjectiveThe aim of this study was to estimate 10-year cardiovascular disease (CVD) risk among Bangladeshi rural community residents, using the 2014 WHO/International Society of Hypertension (WHO/ISH) risk prediction charts.Study designCross-sectional population-based study done by local community healthcare workers engaging the lowest level facilities of the primary healthcare system.Setting and participantsA total of 1545 rural adults aged ≥40 years of Debhata upazila of Satkhira district of Bangladesh participated in this survey done in 2015. The community health workers collected data on age, smoking, blood pressure, blood glucose and treatment history of diabetes and hypertension.Primary outcome measuresWe estimated total 10-year CVD risk using the WHO/ISH South East Asia Region-D charts without cholesterol and categorised the risk into low (<10%), moderate (10%–19.9%), high (20%–29.9%) and very high (≥30%).ResultsThe participants’ mean age (±SD) was 53.9±11.6 years. Overall, the 10-year CVD risks (%, 95% CI) were as follows: low risk (81.6%, 95% CI 78.4% to 84.6%), moderate risk (9.9%, 95% CI 7.4% to 12.1%), high risk (5.8%, 95% CI 4.4% to 7.2%) and very high risk (2.8%, 95% CI 1.5% to 4.1%). In women, moderate to very high risks were higher (moderate 12.1%, high 6.1% and very high 3.7%) compared with men (moderate 7.5%, high 5.5% and very high 1.9%) but none of these were statistically significant. The age-standardised prevalence of very high risk increased from 2.9% (0.7%–5.2%) to 8.5% (5%–12%) when those with anti-hypertensive medication having controlled blood pressure (<140/90 mm Hg) added.ConclusionThe very high-risk estimates could be used for planning resource for CVD prevention programme at upazila level. There is a need for a national level study, covering diversities of rural areas, to contribute to national planning of CVD prevention.

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“…26 Finally, in an urban Bangladeshi population of 150 adults, 3.4% had high CVD risk (≥20%), which is lower than expected as the population was urban. 27 No other studies in Bangladesh have been conducted to assess the 10-year risk of CVD using WHO CVD risk prediction charts. We present novel data using the 2019 charts and a nationally representative sample, which may be generalisable to the population of Bangladesh.…”

Section: Comparison Of Cost By Approachmentioning

confidence: 99%

Estimation of total cardiovascular risk using the 2019 WHO CVD prediction charts and comparison of population-level costs based on alternative drug therapy guidelines: a population-based study of adults in Bangladesh

et al. 2020

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ObjectiveThe objective of this study was to estimate the population distribution of 10-year cardiovascular disease (CVD) risk among Bangladeshi adults aged 40 years and above, using the 2019 WHO CVD risk prediction charts. Additionally, we compared the cost of CVD pharmacological treatment based on the total CVD risk (thresholds ≥30%/≥20%) and the single risk factor (hypertension) cut-off levels in the Bangladeshi context.Study designCross-sectional, population-based study.Setting and participantsFrom 2013 to 2014, we collected data from a nationally representative cross-sectional survey of adults aged ≥40 years from urban and rural areas of Bangladesh (n=6189). We estimated CVD risk using the 2019 WHO CVD risk prediction charts and categorised as very low (<5%), low (5% to <10%), moderate (10% to <20%), high (20% to <30%) and very high risk (≥30%). We estimated drug therapy costs using the lowest price of each drug class available (aspirin, thiazide diuretics, statins and ACE inhibitors). We compared the total cost of drug therapy using the total CVD risk versus single risk factor approach.Primary outcome measuresOur primary outcome was 10-year CVD risk categorised as very low (<5%), low (5% to <10%), moderate (10% to <20%), high (20% to <30%) and very high risk (≥30%).ResultsThe majority of adults (85.2%, 95% CI 84.3 to 86.1) have a 10-year CVD risk of less than 10%. The proportion of adults with a 10-year CVD risk of ≥20% was 0.51%. Only one adult was categorised with a 10-year CVD risk of ≥30%. Among adults with CVD risk groups of very low, low and moderate, 17.4%, 27.9% and 41.4% had hypertension (blood pressure (BP) ≥140/90) and 0.1%, 1.7% and 2.9% had severe hypertension (BP ≥160/100), respectively. Using the total CVD risk approach would reduce drug costs per million populations to US$144 540 (risk of ≥20%).ConclusionTo reduce healthcare expenditure for the prevention and treatment of CVD, a total risk approach using the 2019 WHO CVD risk prediction charts may lead to cost savings.

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Cardiovascular Risk Assessment Among Urban Population of Bangladesh Using WHO/ISH Risk Prediction Chart.

Cited by 4 publications

References 0 publications

Assessment of cardiovascular risk in a slum population in Kenya: use of World Health Organisation/International Society of Hypertension (WHO/ISH) risk prediction charts - secondary analyses of a household survey

Assessment of cardiovascular risk in a slum population in Kenya: use of World Health Organisation/International Society of Hypertension (WHO/ISH) risk prediction charts - secondary analyses of a household survey

Estimated total cardiovascular risk in a rural area of Bangladesh: a household level cross-sectional survey done by local community health workers

Estimation of total cardiovascular risk using the 2019 WHO CVD prediction charts and comparison of population-level costs based on alternative drug therapy guidelines: a population-based study of adults in Bangladesh

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