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New CVD risk score can be adjusted for use in any country
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A new risk equation can be recalibrated for application in any country with routinely available information, researchers reported in The Lancet Diabetes & Endocrinology.
The risk score, called Globorisk, measures risk for CHD or stroke in adults aged 40 years and older by factoring in smoking status, BP, diabetes status and total cholesterol, while adjusting for the effects of age and sex on CVD in different countries. Adding BMI to the risk factors did not improve risk prediction, the researchers wrote.
“Globorisk is an important advance in the field of global [CVD] prevention,” Goodarz Danaei, ScD, assistant professor of global health at the Harvard H.T. Chan School of Public Health, said in a press release. “Until now, most prediction scores were developed using a single cohort study and were never validated for accuracy in national populations for low- and middle-income countries. Therefore, clinicians and public health policy makers in these countries were left without a reliable tool to predict [CV] risk in their patients, community or country.”
Danaei and colleagues used data from eight prospective cohort studies (n = 33,323 men, 16,806 women; mean age, 55 years) to estimate coefficients of the risk equation, and developed risk equations for fatal CVD and for fatal plus nonfatal CVD. They validated the equations internally and in three studies that were not among those used to create the equations.
The researchers then used the risk-prediction equation and date from national health surveys from 2006 or later to estimate the proportion of the population at different levels of CVD risk in 11 countries, including the U.S., from different regions.
Good discrimination
The fatal CVD risk score had a C-statistic of 71% (95% CI, 70-73) in internal validation and a median C-statistic of 73.5% (range, 60-78) when data from different cohorts were held back and used for validation, according to the researchers. The C-statistics for external validation in three different cohorts were 74% (95% CI, 71-77), 83% (95% CI, 79-86) and 84% (95% CI, 82-87).
At any age and risk factor level, the estimated 10-year fatal CVD risk varied widely between countries, according to the researchers.
In South Korea, Spain and Denmark, 5% to 10% of people had greater than 10% 10-year risk for fatal CVD, while 62% to 77% of men and 79% to 82% of women had less than 3% 10-year risk for fatal CVD, Danaei and colleagues wrote. Meanwhile, in China, 33% of men and 28% of women had greater than 10% 10-year risk for fatal CVD, while only 37% of men and 42% of women had less than 3% risk. In Mexico, 16% of men and 11% of women had greater than 10% 10-year risk for fatal CVD, while only 55% of men and 69% of women had less than 3% risk.
“Our reformulation of the risk model to include age- and sex-specific death rates is epidemiologically well-established and allows the variation of age and sex patterns of [CVD] risk across countries and over time to be taken into account,” Danaei and colleagues wrote. “Our risk score also overcomes the methodological limitation of the WHO risk score, the coefficients of which are based on separate analyses of individual risk factors.”
Potential tool for risk management
In a related editorial, Karel G.M. Moons, PhD, and Ewoud Schuit, PhD, both from the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands, wrote that “these predictions might further help, and indeed convince, decision-makers across the world to decide on wide-scale introduction of risk-based management for [CVD].”
“Estimates of country-specific 10-year [CVD]-risk groups can be combined with known effect sizes from randomized trials of various treatments (eg, lipid-lowering and BP-lowering drugs), supplemented with treatment adherence figures, to quantify the expected decrease in [CVD] burden per country within 10 years,” they wrote. – by Erik Swain
Disclosure: One researcher reports receiving consultant fees from Amgen and Sanofi and serving on an advisory board for Novartis. The other researchers, Moons and Schuit report no relevant financial disclosures.
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