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

Abstract

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.

Ten-years cardiovascular risk among Bangladeshi population using non-laboratory-based risk chart of the World Health Organization: Findings from a nationally representative survey

“…The parameters used in the risk algorithm of the non-laboratory-based chart were age (in years), sex (male vs. female), smoking status (no vs. yes), body mass index (BMI) as weight in kg divided by height in squared-meter, and systolic blood pressure (SBP) in mmHg. Although this chart can provide the exact risk score of individuals aged 40 to 74 years, it can also stratify the people of this age group into six groups based on the calculated risk score–very low risk (<5%), low risk (5% to <10%), moderate risk (10% to <20%), high risk (20% to <30%) and very high risk (≥30%) to implement different management protocols [ 16 ].…”

Geographic and Sociodemographic Disparities in Cardiovascular Risk in Burkina Faso: Findings from a Nationwide Cross-Sectional Survey

“…[5][6][7][8] Two strategies are applicable to achieve this goal: the use of a single-risk-factor management strategy, which focuses on one condition at a time (risk-factor approach), and the use of a more holistic approach considering several risk factors through an absolute CVD risk assessment (risk stratification approach). 9 The costeffective interventions based on each of these approaches are discussed in the literature. 5,8,9 Recent studies in lowresource settings have shown the benefits of the absolute CVD risk approach.…”

“… 9 The cost-effective interventions based on each of these approaches are discussed in the literature. 5 , 8 , 9 Recent studies in low-resource settings have shown the benefits of the absolute CVD risk approach. 5 , 9 Risk assessment is a crucial step in the current approach to the primary prevention of atherosclerotic CVD, particularly in low-income countries such as Burkina Faso.…”

“… 5 , 8 , 9 Recent studies in low-resource settings have shown the benefits of the absolute CVD risk approach. 5 , 9 Risk assessment is a crucial step in the current approach to the primary prevention of atherosclerotic CVD, particularly in low-income countries such as Burkina Faso. 10 As stated in many international guidelines, the current approach to the primary prevention of CVD is based on absolute risk assessment.…”

“…This risk chart (called WHO 2019 updated risk chart (WHO risk)) has been used to estimate population-wide distribution of CVD risk in China 27 and Bangladesh. 9 Recently, Peiris et al 28 have used WHO risk to estimate the 10-year cardiovascular risk in 45 low and middle income countries including 18 countries of Africa. This study had found out that the CVD risk tended to be lower in sub-Saharan Africa compared with other world regions.…”