Validation of the World Health Organization/ International Society of Hypertension (WHO/ISH) cardiovascular risk predictions in Sri Lankans based on findings from a prospective cohort study

Abstract

Introduction and objectives There are no cardiovascular (CV) risk prediction models for Sri Lankans. Different risk prediction models not validated for Sri Lankans are being used to predict CV risk of Sri Lankans. We validated the WHO/ISH (SEAR-B) risk prediction charts prospectively in a population-based cohort of Sri Lankans. Method We selected 40–64 year-old participants from the Ragama Medical Officer of Health (MOH) area in 2007 by stratified random sampling and followed them up for 10 years. Ten-year risk predictions of a fatal/non-fatal cardiovascular event (CVE) in 2007 were calculated using WHO/ISH (SEAR-B) charts with and without cholesterol. The CVEs that occurred from 2007–2017 were ascertained. Risk predictions in 2007 were validated against observed CVEs in 2017. Results Of 2517 participants, the mean age was 53.7 year (SD: 6.7) and 1132 (45%) were males. Using WHO/ISH chart with cholesterol, the percentages of subjects with a 10-year CV risk <10%, 10–19%, 20%-29%, 30–39%, ≥40% were 80.7%, 9.9%, 3.8%, 2.5% and 3.1%, respectively. 142 non-fatal and 73 fatal CVEs were observed during follow-up. Among the cohort, 9.4% were predicted of having a CV risk ≥20% and 8.6% CVEs were observed in the risk category. CVEs were within the predictions of WHO/ISH charts with and without cholesterol in both high (≥20%) and low(<20%) risk males, but only in low(<20%) risk females. The predictions of WHO/ISH charts, with-and without-cholesterol were in agreement in 81% of subjects (ĸ = 0.429; p<0.001). Conclusions WHO/ISH (SEAR B) risk prediction charts with-and without-cholesterol may be used in Sri Lanka. Risk charts are more predictive in males than in females and for lower-risk categories. The predictions when stratifying into 2 categories, low risk (<20%) and high risk (≥20%), are more appropriate in clinical practice.

Cardiovascular disease risk profile and management among people 40 years of age and above in Bo, Sierra Leone: A cross-sectional study

“…The primary outcome measure was the proportion of the study sample defined as being at high 10-year risk of having a cardiovascular event, here defined as >20% risk as done in previous studies [33]. The WHO/ISH Risk score includes age, gender, smoking, diabetes, blood pressure, cholesterol and appropriate WHO epidemiological sub region [34].…”

Estimation of Cardiovascular Risk Profile among Diabetic Patients Attending Tertiary Care Hospital

“…This could be explained by gender-specific factors such as menopause, hormonal imbalances, pregnancy-related complications, and polycystic ovarian syndrome, etc., which are not taken into the calculation of WHO/ISH risk prediction charts. 21 The high percentage of participants categorized as having a low CVD risk of less than 10% in this study highlights the fact that there is a scope for its reduction by employing population-wide public health policy and an opportunity to utilize preventive services.…”

“…This could be explained by gender-specific factors such as menopause, hormonal imbalances, pregnancy-related complications, and polycystic ovarian syndrome, etc., which are not taken into the calculation of WHO/ISH risk prediction charts. 21…”

Atherosclerotic cardiovascular disease risk among Ghanaians: A comparison of the risk assessment tools.

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