Cardiovascular Risk Assessment in Developing World

Chamnan, Parinya; Aekplakorn, Wichai

doi:10.5772/intechopen.69041

Cited by 6 publications

(4 citation statements)

References 42 publications

(46 reference statements)

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“…A population-based approach to CVD risk scores is advantageous since existing risk score estimates seem to perform poorly in the developing countries and may lead to misclassification of individuals who do and do not require treatments (Chamnan & Aekplakorn, 2017). Whilst many developing countries solely describe estimated cardiovascular risk by applying existing CVD risk scores to their populations' cross-sectional data, a number of countries have validated and recalibrated existing risk scores and only a few have developed new risk scores specific to their populations (Yamwong, 2005;Wu et al, 2006;Assmann, Cullen & Schulte, 1998).…”

Section: Introductionmentioning

confidence: 99%

Evaluating Cardiovascular Disease (CVD) risk scores for participants with known CVD and non-CVD in a multiracial/ethnic Caribbean sample

Hosein

Stoute

Chadee

et al. 2020

PeerJ

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Background Cardiovascular Disease (CVD) risk prediction models have been useful in estimating if individuals are at low, intermediate, or high risk, of experiencing a CVD event within some established time frame, usually 10 years. Central to this is the concern in Trinidad and Tobago of using pre-existing CVD risk prediction methods, based on populations in the developed world (e.g. ASSIGN, Framingham and QRISK®2), to establish risk for its multiracial/ethnic Caribbean population. The aim of this study was to determine which pre-existing CVD risk method is best suited for predicting CVD risk for individuals in this population. Method A survey was completed by 778 participants, 526 persons with no prior CVD, and 252 who previously reported a CVD event. Lifestyle and biometric data was collected from non-CVD participants, while for CVD participants, medical records were used to collect data at the first instance of CVD. The performances of three CVD risk prediction models (ASSIGN, Framingham and QRISK®2) were evaluated using their calculated risk scores. Results All three models (ASSIGN, Framingham and QRISK®2) identified less than 62% of cases (CVD participants) with a high proportion of false-positive predictions to true predictions as can be seen by positive predictabilities ranging from 78% (ASSIGN and Framingham) to 87% (QRISK®2). Further, for all three models, individuals whose scores fell into the misclassification range were 2X more likely to be individuals who had experienced a prior CVD event as opposed to healthy individuals. Conclusion The ASSIGN, Framingham and QRISK®2 models should be utilised with caution on a Trinidad and Tobago population of intermediate and high risk for CVD since these models were found to have underestimated the risk for individuals with CVD up to 2.5 times more often than they overestimated the risk for healthy persons.

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Section: Introductionmentioning

confidence: 99%

Evaluating Cardiovascular Disease (CVD) risk scores for participants with known CVD and non-CVD in a multiracial/ethnic Caribbean sample

Hosein

Stoute

Chadee

et al. 2020

PeerJ

View full text Add to dashboard Cite

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“…In addition, categorizing people into low and moderate CVD risk may give them a false reassurance that they are protected from stroke/CVD, thus attenuating any motivation to control their risk factors [60]. There is also evidence that existing CVD risk score estimates perform poorly in the developing countries and may lead to misclassification of individuals who do and do not require treatments [61,62]. For example, a 45-year-old man who smokes cigarettes, is physically inactive and has usual blood pressure of 140/90 mmHg has a 10-year absolute CVD risk of 2.4%-2.5% (according to the ACC/AHA ASCVD and QRISK®2-2014 algorithms) and a 5-year absolute CVD risk of 1.3% (according to the PREDICT algorithm).…”

Section: Risk Stratification Management and Treatment Thresholdsmentioning

confidence: 99%

Twenty years on from the introduction of the high risk strategy for stroke and cardiovascular disease prevention: a systematic scoping review

Feigin,

Martins,

Brainin

et al. 2023

Euro J of Neurology

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Background and purposeEarly this century, the high risk strategy of primary stroke and cardiovascular disease (CVD) prevention for individuals shifted away from identifying (and treating, as appropriate) all at‐risk individuals towards identifying and treating individuals who exceed arbitrary thresholds of absolute CVD risk. The public health impact of this strategy is uncertain.MethodsIn our systematic scoping review, the electronic databases (Scopus, MEDLINE, Embase, Google Scholar, Cochrane Library) were searched to identify and appraise publications related to primary CVD/stroke prevention strategies and their effectiveness published in any language from January 1990 to August 2023.ResultsNo published randomized controlled trial was found on the effectiveness of the high CVD risk strategy for primary stroke/CVD prevention. Targeting high CVD risk individuals excludes a large proportion of the population from effective blood‐pressure‐lowering and lipid‐lowering treatment and effective CVD prevention. There is also evidence that blood pressure lowering and lipid lowering are beneficial irrespective of blood pressure and cholesterol levels and irrespective of absolute CVD risk and that risk‐stratified pharmacological management of blood pressure and lipids to only high CVD risk individuals leads to significant underuse of blood‐pressure‐lowering and lipid‐lowering medications in individuals otherwise eligible for such treatment.ConclusionsPrimary stroke and CVD prevention needs to be done in all individuals with increased risk of CVD/stroke. Pharmacological management of blood pressure and blood cholesterol should not be solely based on the high CVD risk treatment thresholds. International guidelines and global strategies for primary CVD/stroke prevention need to be revised.

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“…These tools however are not specifically validated for use in the Asian population. Among Asian countries, Malaysia has validated and uses the Framingham Risk Score and Thailand uses panel scoring method [24,25]. Compared with these countries, the Philippines does not have a locally validated CV risk scoring system.…”

Section: Factors Possibly Contributing To Low Screening Rate and Subo...mentioning

confidence: 99%

Management of Dyslipidemia and Hypertension – Journey Mapping in the Philippines

et al. 2022

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Literature was reviewed semi-systematically with the purpose of generating Philippines-specific data for the patient journey stages for dyslipidemia and hypertension, namely, awareness, screening, diagnosis, treatment, adherence, and control. A structured search was conducted on EMBASE and MEDLINE databases for studies published in English in the last 10 years, whose full text was available. An unstructured search was conducted on Google, and websites of health ministries and international organizations, without any limits. The last search was run for dyslipidemia on 12.11.2019 and for hypertension on 28.07.2020. For dyslipidemia, six records out of 590 records were retrieved, and for hypertension, seven records and one unpublished conference presentation out of 160 records retrieved, were included in the final synthesis. The review estimated that in the Philippines, the prevalence of dyslipidemia was 38.8%, while 59.0% of patients were undergoing treatment, with 44.2% of patients achieving control. Prevalence of hypertension was 27.5% and estimated rates at different stages of patient journey were- awareness- 61.5%, screening- 3.2%, diagnosis- 39.7%, treatment- 65.4%, adherence- 57%, and control- 57.6%. Potential contributory factors for low assessment rates and suboptimal management include low doctor-to-population ratio, inadequate time for screening and counseling, absence of locally validated tools for cardiovascular screening, low awareness and utilization of clinical practice guidelines, and some misperceptions of current treatment recommendations. Effective training of physicians, patient education initiatives, and multi-sectoral coordination are some of the recommendations to improve the status of management of dyslipidemia and hypertension in the Philippines.

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Cardiovascular Risk Assessment in Developing World

Cited by 6 publications

References 42 publications

Evaluating Cardiovascular Disease (CVD) risk scores for participants with known CVD and non-CVD in a multiracial/ethnic Caribbean sample

Evaluating Cardiovascular Disease (CVD) risk scores for participants with known CVD and non-CVD in a multiracial/ethnic Caribbean sample

Twenty years on from the introduction of the high risk strategy for stroke and cardiovascular disease prevention: a systematic scoping review

Management of Dyslipidemia and Hypertension – Journey Mapping in the Philippines

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