We are analyzing https://link.springer.com/article/10.1186/1471-2458-13-539.

Title:
Assessment of total cardiovascular risk using WHO/ISH risk prediction charts in three low and middle income countries in Asia | BMC Public Health
Description:
Background Recent research has used cardiovascular risk scores intended to estimate “total cardiovascular disease (CVD) risk” in individuals to assess the distribution of risk within populations. The research suggested that the adoption of the total risk approach, in comparison to treatment decisions being based on the level of a single risk factor, could lead to reductions in expenditure on preventive cardiovascular drug treatment in low- and middle-income countries. So that the patient benefit associated with savings is highlighted. Methods This study used data from national STEPS surveys (STEPwise Approach to Surveillance) conducted between 2005 and 2010 in Cambodia, Malaysia and Mongolia of men and women aged 40–64 years. The study compared the differences and implications of various approaches to risk estimation at a population level using the World Health Organization/International Society of Hypertension (WHO/ISH) risk score charts. To aid interpretation and adjustment of scores and inform treatment in individuals, the charts are accompanied by practice notes about risk factors not included in the risk score calculations. Total risk was calculated amongst the populations using the charts alone and also adjusted according to these notes. Prevalence of traditional single risk factors was also calculated. Results The prevalence of WHO/ISH “high CVD risk” (≥20% chance of developing a cardiovascular event over 10 years) of 6%, 2.3% and 1.3% in Mongolia, Malaysia and Cambodia, respectively, is in line with recent research when charts alone are used. However, these proportions rise to 33.3%, 20.8% and 10.4%, respectively when individuals with blood pressure > = 160/100 mm/Hg and/or hypertension medication are attributed to “high risk”. Of those at “moderate risk” (10- < 20% chance of developing a cardio vascular event over 10 years), 100%, 94.3% and 30.1%, respectively are affected by at least one risk-increasing factor. Of all individuals, 44.6%, 29.0% and 15.0% are affected by hypertension as a single risk factor (systolic ≥ 140 mmHg or diastolic ≥ 90 mmHg or medication). Conclusions Used on a population level, cardiovascular risk scores may offer useful insights that can assist health service delivery planning. An approach based on overall risk without adjustment of specific risk factors however, may underestimate treatment needs. At the individual level, the total risk approach offers important clinical benefits. However, countries need to develop appropriate clinical guidelines and operational guidance for detection and management of CVD risk using total CVD-risk approach at different levels of health system. Operational research is needed to assess implementation issues.
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Keywords {🔍}

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Topics {✒️}

org/data/views/reports/tableview world health organization resting pulse rate total cvd-risk approach risk-increasing factors mentioned western pacific region bmc public health high-risk category increased raised pulse rate multi-factorial interventions overtime upper middle-income country /ish risk-prediction charts article download pdf lower-middle-income country single risk factor single-factor approach nationally representative cohort ruth bonita reviewed cross-sectional population data /ish risk score risk-increasing factor risk score calculations target organ damage risk score charts cardiovascular risk factor total risk approach risk factor reduction risk-elevating factor systolic blood pressure ≥ 140 mmhg diastolic blood pressure ≥ 90 mmhg single risk factors resting heart rate total cvd risk �total’ cvd risk privacy choices/manage cookies pre-publication history individual-based primary prevention full access reported cholesterol-lowering medication total cardiovascular risk laboratory-based versus single risk modification metabolic equivalent joint task force �total’’ predicted risk reported anti-hypertensive medication 10-year total risk total risk scores cardiovascular risk assessment cardiovascular risk assessment

Questions {❓}

Cook S, Togni M, Schaub MC, Wenawesen P, Hess OM: High heart rate: a cardiovascular risk factor?
Ferket BS, Colkesen EB, Visser JJ, et al: Systematic review of guidelines on cardiovascular risk assessment: which recommendations should clinicians follow for a cardiovascular health check?

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