Comparative assessment of absolute cardiovascular disease risk characterization from non-laboratory-based risk assessment in South African populations

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dc.contributor.authorGaziano, Thomas A
dc.contributor.authorPandya, Ankur
dc.contributor.authorSteyn, Krisela
dc.contributor.authorLevitt, Naomi
dc.contributor.authorMollentze, Willie
dc.contributor.authorJoubert, Gina
dc.contributor.authorWalsh, Corinna M
dc.contributor.authorMotala, Ayesha A
dc.contributor.authorKruger, Annamarie
dc.contributor.authorSchutte, Aletta E
dc.contributor.authorNaidoo, Datshana P
dc.contributor.authorPrakaschandra, Dorcas R
dc.contributor.authorLaubscher, Ria
dc.coverage.spatialSouth Africaen_ZA
dc.date.accessioned2015-02-16T12:49:54Z
dc.date.available2015-02-16T12:49:54Z
dc.date.issued2013-07-24
dc.date.updated2015-01-15T17:57:56Z
dc.description.abstractBackground: All rigorous primary cardiovascular disease (CVD) prevention guidelines recommend absolute CVD risk scores to identify high- and low-risk patients, but laboratory testing can be impractical in low- and middle-income countries. The purpose of this study was to compare the ranking performance of a simple, non-laboratory-based risk score to laboratory-based scores in various South African populations. Methods: We calculated and compared 10-year CVD (or coronary heart disease (CHD)) risk for 14,772 adults from thirteen cross-sectional South African populations (data collected from 1987 to 2009). Risk characterization performance for the non-laboratory-based score was assessed by comparing rankings of risk with six laboratory-based scores (three versions of Framingham risk, SCORE for high- and low-risk countries, and CUORE) using Spearman rank correlation and percent of population equivalently characterized as ‘high’ or ‘low’ risk. Total 10-year non-laboratory-based risk of CVD death was also calculated for a representative cross-section from the 1998 South African Demographic Health Survey (DHS, n = 9,379) to estimate the national burden of CVD mortality risk. Results: Spearman correlation coefficients for the non-laboratory-based score with the laboratory-based scores ranged from 0.88 to 0.986. Using conventional thresholds for CVD risk (10% to 20% 10-year CVD risk), 90% to 92% of men and 94% to 97% of women were equivalently characterized as ‘high’ or ‘low’ risk using the non-laboratory-based and Framingham (2008) CVD risk score. These results were robust across the six risk scores evaluated and the thirteen cross-sectional datasets, with few exceptions (lower agreement between the non-laboratory-based and Framingham (1991) CHD risk scores). Approximately 18% of adults in the DHS population were characterized as ‘high CVD risk’ (10-year CVD death risk >20%) using the non-laboratory-based score. Conclusions: We found a high level of correlation between a simple, non-laboratory-based CVD risk score and commonly-used laboratory-based risk scores. The burden of CVD mortality risk was high for men and women in South Africa. The policy and clinical implications are that fast, low-cost screening tools can lead to similar risk assessment results compared to time- and resource-intensive approaches. Until setting-specific cohort studies can derive and validate country-specific risk scores, non-laboratory-based CVD risk assessment could be an effective and efficient primary CVD screening approach in South Africa.en_ZA
dc.identifier.apacitationGaziano, T. A., Pandya, A., Steyn, K., Levitt, N., Mollentze, W., Joubert, G., ... Laubscher, R. (2013). Comparative assessment of absolute cardiovascular disease risk characterization from non-laboratory-based risk assessment in South African populations. <i>BMC Medicine</i>, http://hdl.handle.net/11427/12482en_ZA
dc.identifier.chicagocitationGaziano, Thomas A, Ankur Pandya, Krisela Steyn, Naomi Levitt, Willie Mollentze, Gina Joubert, Corinna M Walsh, et al "Comparative assessment of absolute cardiovascular disease risk characterization from non-laboratory-based risk assessment in South African populations." <i>BMC Medicine</i> (2013) http://hdl.handle.net/11427/12482en_ZA
dc.identifier.citationGaziano, Thomas A.; Pandya, Ankur; Steyn, Krisela; Levitt, Naomi; Mollentze, Willie; Joubert, Gina; Walsh, Corinna M.; Motala, Ayesha A; Kruger, Annamarie; Schutte, Aletta E; Naidoo, Datshana P.; Prakaschandra, Dorcas R. and Laubscher, Ria. (2013) Comparative assessment of absolute cardiovascular disease risk characterization from non-laboratory-based risk assessment in South African populations. BMC Medicine. 11(1):170-181.en_ZA
dc.identifier.ris TY - Journal Article AU - Gaziano, Thomas A AU - Pandya, Ankur AU - Steyn, Krisela AU - Levitt, Naomi AU - Mollentze, Willie AU - Joubert, Gina AU - Walsh, Corinna M AU - Motala, Ayesha A AU - Kruger, Annamarie AU - Schutte, Aletta E AU - Naidoo, Datshana P AU - Prakaschandra, Dorcas R AU - Laubscher, Ria AB - Background: All rigorous primary cardiovascular disease (CVD) prevention guidelines recommend absolute CVD risk scores to identify high- and low-risk patients, but laboratory testing can be impractical in low- and middle-income countries. The purpose of this study was to compare the ranking performance of a simple, non-laboratory-based risk score to laboratory-based scores in various South African populations. Methods: We calculated and compared 10-year CVD (or coronary heart disease (CHD)) risk for 14,772 adults from thirteen cross-sectional South African populations (data collected from 1987 to 2009). Risk characterization performance for the non-laboratory-based score was assessed by comparing rankings of risk with six laboratory-based scores (three versions of Framingham risk, SCORE for high- and low-risk countries, and CUORE) using Spearman rank correlation and percent of population equivalently characterized as ‘high’ or ‘low’ risk. Total 10-year non-laboratory-based risk of CVD death was also calculated for a representative cross-section from the 1998 South African Demographic Health Survey (DHS, n = 9,379) to estimate the national burden of CVD mortality risk. Results: Spearman correlation coefficients for the non-laboratory-based score with the laboratory-based scores ranged from 0.88 to 0.986. Using conventional thresholds for CVD risk (10% to 20% 10-year CVD risk), 90% to 92% of men and 94% to 97% of women were equivalently characterized as ‘high’ or ‘low’ risk using the non-laboratory-based and Framingham (2008) CVD risk score. These results were robust across the six risk scores evaluated and the thirteen cross-sectional datasets, with few exceptions (lower agreement between the non-laboratory-based and Framingham (1991) CHD risk scores). Approximately 18% of adults in the DHS population were characterized as ‘high CVD risk’ (10-year CVD death risk >20%) using the non-laboratory-based score. Conclusions: We found a high level of correlation between a simple, non-laboratory-based CVD risk score and commonly-used laboratory-based risk scores. The burden of CVD mortality risk was high for men and women in South Africa. The policy and clinical implications are that fast, low-cost screening tools can lead to similar risk assessment results compared to time- and resource-intensive approaches. Until setting-specific cohort studies can derive and validate country-specific risk scores, non-laboratory-based CVD risk assessment could be an effective and efficient primary CVD screening approach in South Africa. DA - 2013-07-24 DB - OpenUCT DO - 10.1186/1741-7015-11-170 DP - University of Cape Town J1 - BMC Medicine LK - https://open.uct.ac.za PB - University of Cape Town PY - 2013 T1 - Comparative assessment of absolute cardiovascular disease risk characterization from non-laboratory-based risk assessment in South African populations TI - Comparative assessment of absolute cardiovascular disease risk characterization from non-laboratory-based risk assessment in South African populations UR - http://hdl.handle.net/11427/12482 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/12482
dc.identifier.urihttp://dx.doi.org/10.1186/1741-7015-11-170
dc.identifier.vancouvercitationGaziano TA, Pandya A, Steyn K, Levitt N, Mollentze W, Joubert G, et al. Comparative assessment of absolute cardiovascular disease risk characterization from non-laboratory-based risk assessment in South African populations. BMC Medicine. 2013; http://hdl.handle.net/11427/12482.en_ZA
dc.languageengen_ZA
dc.language.rfc3066en
dc.publisherBioMed Centralen_ZA
dc.publisher.departmentDepartment of Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsCreative Commons Attribution 4.0 International (CC BY 4.0)*
dc.rights.holderGaziano et al.; licensee BioMed Central Ltd.
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en_ZA
dc.sourceBMC Medicineen_ZA
dc.source.urihttp://www.biomedcentral.com/bmcmed/
dc.subject.lcshCholesterolen_ZA
dc.subject.lcshCoronary heart diseaseen_ZA
dc.subject.otherCardiovascular diseasesen_ZA
dc.subject.otherPreventionen_ZA
dc.subject.otherStrokeen_ZA
dc.titleComparative assessment of absolute cardiovascular disease risk characterization from non-laboratory-based risk assessment in South African populationsen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetype
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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