Cardiovascular risk charts for 182 countries: application of laboratory-based and office-based risk scores to global populations

Journal article

Background: Treatment of cardiovascular risk factors based on risk is an effective strategy for prevention of cardiovascular diseases (CVD). Worldwide implementation of risk-based CVD prevention requires risk prediction tools that are contemporarily recalibrated for the target country, and can be used where laboratory measurements are unavailable. We present two cardiovascular risk scores, with and without laboratory-based measurements; and the corresponding risk charts for 182 countries to predict 10-year risk of fatal and non-fatal cardiovascular disease.

Methods: We used data from eight prospective studies to estimate coefficients of the risk equations using proportional hazard regressions. The laboratory-based risk score included smoking, blood pressure, diabetes and total cholesterol. In the non-laboratory (office-based) risk score, we replaced diabetes and total cholesterol with body mass index. We recalibrated risk scores for each sex and age-group in each country using average risk factor levels and CVD rates. We used recalibrated risk scores and data from national surveys to estimate proportion of the population at different levels of CVD risk in an illustrative subset of 10 countries. We estimated proportion of men and women who were similarly categorized as high-risk or low-risk by the two risk scores.

Findings: Predicted risks for the same risk factor profile were lower in high-income countries than in low- and middle-income countries (LMICs), with the highest risks in countries in Central and Southeast Asia, and Eastern Europe. In the national health surveys, the proportion of people aged 40-64 years at high-risk of CVD ranged from 1% for South Korean women to 41% for Czech men in high-income countries using ≥10% risk to define high-risk, and from 2% in Uganda to 13% in Iranian men in LMICs using a ≥20% risk threshold. More than 80% of adults were similarly classified as low- or high-risk by the laboratory-based and office-based risk scores. However, the office-based model substantially underestimated the risk among diabetes patients.

Interpretation: Our risk charts address a major technical bottleneck for worldwide implementation of risk-based CVD prevention by providing risk assessment tools that are recalibrated for each country, and by making the estimation of CVD risk possible without using laboratory-based measurements.

Authors: Ueda, P; Woodward, M; Lu, Y

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Lancet
• Journal: Lancet Diabetes and Endocrinology
• Volume: 5
• Issue: 3
• Pages: 196–213
• Publication date: 2017-01-23
• Acceptance date: 2016-11-15
• DOI: 10.1016/S2213-8587(17)30015-3
• EISSN: 2213-8595
• ISSN: 2213-8587