TY - JOUR
T1 - Comparison of the performance of cardiovascular risk prediction tools in rural India
T2 - The Rishi Valley Prospective Cohort Study
AU - Birhanu, Mulugeta Molla
AU - Zengin, Ayse
AU - Evans, Roger G.
AU - Joshi, Rohina
AU - Kalyanram, Kartik
AU - Kartik, Kamakshi
AU - Danaei, Goodarz
AU - Barr, Elizabeth
AU - Riddell, Michaela A.
AU - Suresh, Oduru
AU - Srikanth, Velandai K.
AU - Arabshahi, Simin
AU - Thomas, Nihal
AU - Thrift, Amanda G.
N1 - Publisher Copyright:
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2024/4/1
Y1 - 2024/4/1
N2 - Aims We compared the performance of cardiovascular risk prediction tools in rural India. Methods
and results We applied the World Health Organization Risk Score (WHO-RS) tools, Australian Risk Score (ARS), and Global risk
(Globorisk) prediction tools to participants aged 40–74 years, without prior cardiovascular disease, in the Rishi Valley
Prospective Cohort Study, Andhra Pradesh, India. Cardiovascular events during the 5-year follow-up period were identified
by verbal autopsy (fatal events) or self-report (non-fatal events). The predictive performance of each tool was assessed by
discrimination and calibration. Sensitivity and specificity of each tool for identifying high-risk individuals were assessed using a
risk score cut-off of 10% alone or this 10% cut-off plus clinical risk criteria of diabetes in those aged >60 years, high blood
pressure, or high cholesterol. Among 2333 participants (10 731 person-years of follow-up), 102 participants developed a
cardiovascular event. The 5-year observed risk was 4.4% (95% confidence interval: 3.6–5.3). The WHO-RS tools underestimated cardiovascular risk but the ARS overestimated risk, particularly in men. Both the laboratory-based (C-statistic: 0.68
and χ
2
: 26.5, P = 0.003) and non–laboratory-based (C-statistic: 0.69 and χ
2
: 20.29, P = 0.003) Globorisk tools showed relatively good discrimination and agreement. Addition of clinical criteria to a 10% risk score cut-off improved the diagnostic
accuracy of all tools. Conclusion Cardiovascular risk prediction tools performed disparately in a setting of disadvantage in rural India, with the Globorisk performing best. Addition of clinical criteria to a 10% risk score cut-off aids assessment of risk of a cardiovascular event in rural
India. Lay summary In a cohort of people without prior cardiovascular disease, tools used to predict the risk of cardiovascular events varied
widely in their ability to accurately predict who would develop a cardiovascular event. • The Globorisk, and to a lesser extent the ARS, tools could be appropriate for this setting in rural India. • Adding clinical criteria, such as sustained high blood pressure, to a cut-off of 10% risk of a cardiovascular event within 5
years could improve identification of individuals who should be monitored closely and provided with appropriate preventive medications.
AB - Aims We compared the performance of cardiovascular risk prediction tools in rural India. Methods
and results We applied the World Health Organization Risk Score (WHO-RS) tools, Australian Risk Score (ARS), and Global risk
(Globorisk) prediction tools to participants aged 40–74 years, without prior cardiovascular disease, in the Rishi Valley
Prospective Cohort Study, Andhra Pradesh, India. Cardiovascular events during the 5-year follow-up period were identified
by verbal autopsy (fatal events) or self-report (non-fatal events). The predictive performance of each tool was assessed by
discrimination and calibration. Sensitivity and specificity of each tool for identifying high-risk individuals were assessed using a
risk score cut-off of 10% alone or this 10% cut-off plus clinical risk criteria of diabetes in those aged >60 years, high blood
pressure, or high cholesterol. Among 2333 participants (10 731 person-years of follow-up), 102 participants developed a
cardiovascular event. The 5-year observed risk was 4.4% (95% confidence interval: 3.6–5.3). The WHO-RS tools underestimated cardiovascular risk but the ARS overestimated risk, particularly in men. Both the laboratory-based (C-statistic: 0.68
and χ
2
: 26.5, P = 0.003) and non–laboratory-based (C-statistic: 0.69 and χ
2
: 20.29, P = 0.003) Globorisk tools showed relatively good discrimination and agreement. Addition of clinical criteria to a 10% risk score cut-off improved the diagnostic
accuracy of all tools. Conclusion Cardiovascular risk prediction tools performed disparately in a setting of disadvantage in rural India, with the Globorisk performing best. Addition of clinical criteria to a 10% risk score cut-off aids assessment of risk of a cardiovascular event in rural
India. Lay summary In a cohort of people without prior cardiovascular disease, tools used to predict the risk of cardiovascular events varied
widely in their ability to accurately predict who would develop a cardiovascular event. • The Globorisk, and to a lesser extent the ARS, tools could be appropriate for this setting in rural India. • Adding clinical criteria, such as sustained high blood pressure, to a cut-off of 10% risk of a cardiovascular event within 5
years could improve identification of individuals who should be monitored closely and provided with appropriate preventive medications.
KW - Epidemiology Cardiovascular disease Risk prediction Risk score Prevention Low- and middle-income countries
UR - http://www.scopus.com/inward/record.url?scp=85186393833&partnerID=8YFLogxK
U2 - 10.1093/eurjpc/zwad404
DO - 10.1093/eurjpc/zwad404
M3 - Article
C2 - 38149975
AN - SCOPUS:85186393833
SN - 2047-4873
VL - 31
SP - 723
EP - 731
JO - European Journal of Preventive Cardiology
JF - European Journal of Preventive Cardiology
IS - 6
ER -
