TY - JOUR
T1 - Agreement between cardiovascular disease risk scores in resource-limited settings
T2 - Evidence from 5 Peruvian sites
AU - Bazo-Alvarez, Juan Carlos
AU - Quispe, Renato
AU - Peralta, Frank
AU - Poterico, Julio A.
AU - Valle, Giancarlo A.
AU - Burroughs, Melissa
AU - Pillay, Timesh
AU - Gilman, Robert H.
AU - Checkley, William
AU - Malaga, Germán
AU - Smeeth, Liam
AU - Bernabé-Ortiz, Antonio
AU - Miranda, J. Jaime
N1 - Funding Information:
Supported by the Seed Grant that has been funded in whole with Federal funds by the United States National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under Purchase Order No. HHSN268200900034C. The CRONICAS Cohort Study was funded in whole with Federal funds from the United States National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under contract No. HHSN268200900033C. The PERU MIGRANT Study was funded by the Wellcome Trust (GR074833MA) and Universidad Peruana Cayetano Heredia (Fondo Concursable No. 20205071009). William Checkley was further supported by a Pathway to Independence Award (R00HL096955) from the National Heart, Lung and Blood Institute. Liam Smeeth is a Senior Clinical Fellow funded by Wellcome Trust.
Funding Information:
From the *CRONICAs Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; †santa Cruz de Ratacocha Primary Healthcare Centre, social service in Rural setting, Ministry of Health, Huanuco, Peru; ‡Division of Cardiology, Department of Medicine, §Duke Clinical Research Institute, ¶Duke Global Health Institute, Duke University, Durham, NC; ║school of Medicine, University College London, London, UK; **Department of International Health, Johns Hopkins Bloomberg school of Public Health, Baltimore, MD; ††Asociación Benéfica PRIsMA, Lima, Peru; ‡‡Division of Pulmonary and Critical Care, school of Medicine, Johns Hopkins University, Baltimore, MD; §§Department of Medicine, school of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru; and ¶¶Faculty of Epidemiology and Population Health, London school of Hygiene and Tropical Medicine, London, UK. supported by the seed Grant that has been funded in whole with Federal funds by the United states National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human services, under Purchase Order No. HHsN268200900034C. The CRONICAs Cohort study was funded in whole with Federal funds from the United states National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human services, under contract No. HHsN268200900033C. The PERU MIGRANT study was funded by the Wellcome Trust (GR074833MA) and Universidad Peruana Cayetano Heredia (Fondo Concursable No. 20205071009). William Checkley was further supported by a Pathway to Independence Award (R00HL096955) from the National Heart, Lung and Blood Institute. Liam smeeth is a senior Clinical Fellow funded by Wellcome Trust.
Publisher Copyright:
© 2015 Wolters Kluwer Health, Inc.
PY - 2015/6/1
Y1 - 2015/6/1
N2 - It is unclear how well currently available risk scores predict cardiovascular disease (CVD) risk in low-income and middle-income countries. We aim to compare the American College of Cardiology/American Heart Association (ACC/AHA) Pooled Cohort risk equations (ACC/AHA model) with 6 other CVD risk tools to assess the concordance of predicted CVD risk in a random sample from 5 geographically diverse Peruvian populations. We used data from 2 Peruvian, age and sex-matched, population-based studies across 5 geographical sites. The ACC/AHA model were compared with 6 other CVD risk prediction tools: laboratory Framingham risk score for CVD, non-laboratory Framingham risk score for CVD, Reynolds risk score, systematic coronary risk evaluation, World Health Organization risk charts, and the Lancet chronic diseases risk charts. Main outcome was in agreement with predicted CVD risk using Lin's concordance correlation coefficient. Two thousand one hundred and eighty-three subjects, mean age 54.3 (SD ± 5.6) years, were included in the analysis. Overall, we found poor agreement between different scores when compared with ACC/AHA model. When each of the risk scores was used with cut-offs specified in guidelines, ACC/AHA model depicted the highest proportion of people at high CVD risk predicted at 10 years, with a prevalence of 29.0% (95% confidence interval, 26.9-31.0%), whereas prevalence with World Health Organization risk charts was 0.6% (95% confidence interval, 0.2-8.6%). In conclusion, poor concordance between current CVD risk scores demonstrates the uncertainty of choosing any of them for public health and clinical interventions in Latin American populations. There is a need to improve the evidence base of risk scores for CVD in low-income and middle-income countries.
AB - It is unclear how well currently available risk scores predict cardiovascular disease (CVD) risk in low-income and middle-income countries. We aim to compare the American College of Cardiology/American Heart Association (ACC/AHA) Pooled Cohort risk equations (ACC/AHA model) with 6 other CVD risk tools to assess the concordance of predicted CVD risk in a random sample from 5 geographically diverse Peruvian populations. We used data from 2 Peruvian, age and sex-matched, population-based studies across 5 geographical sites. The ACC/AHA model were compared with 6 other CVD risk prediction tools: laboratory Framingham risk score for CVD, non-laboratory Framingham risk score for CVD, Reynolds risk score, systematic coronary risk evaluation, World Health Organization risk charts, and the Lancet chronic diseases risk charts. Main outcome was in agreement with predicted CVD risk using Lin's concordance correlation coefficient. Two thousand one hundred and eighty-three subjects, mean age 54.3 (SD ± 5.6) years, were included in the analysis. Overall, we found poor agreement between different scores when compared with ACC/AHA model. When each of the risk scores was used with cut-offs specified in guidelines, ACC/AHA model depicted the highest proportion of people at high CVD risk predicted at 10 years, with a prevalence of 29.0% (95% confidence interval, 26.9-31.0%), whereas prevalence with World Health Organization risk charts was 0.6% (95% confidence interval, 0.2-8.6%). In conclusion, poor concordance between current CVD risk scores demonstrates the uncertainty of choosing any of them for public health and clinical interventions in Latin American populations. There is a need to improve the evidence base of risk scores for CVD in low-income and middle-income countries.
KW - cardiovascular diseases
KW - Peru
KW - vulnerable populations
UR - http://www.scopus.com/inward/record.url?scp=84966495211&partnerID=8YFLogxK
U2 - 10.1097/HPC.0000000000000045
DO - 10.1097/HPC.0000000000000045
M3 - Article
C2 - 26102017
AN - SCOPUS:84966495211
SN - 1535-282X
VL - 14
SP - 74
EP - 80
JO - Critical Pathways in Cardiology
JF - Critical Pathways in Cardiology
IS - 2
ER -