Place of cardiovascular risk prediction models in South Asians;
agreement between Framingham risk score and WHO/ISH risk charts
Abstract
Introduction and Objectives There are no cardiovascular risk prediction
models developed in South Asian cohorts. Therefore, different risk
models not validated in South Asians are being used. We aimed to compare
cardiovascular risk predictions of Framingham risk score (FRS) and World
health organization/International society of hypertension (WHO/ISH)
charts for agreement in a sample of South Asians. Methods 10-year
cardiovascular risk predictions of patients without previous
cardiovascular diseases attending a non-communicable disease clinic were
calculated using FRS (with BMI and with cholesterol) and WHO/ISH charts
(with and without cholesterol). Patients were categorized into
low(<20% ) and high(≥20%) cardiovascular risk groups on risk
predictions. Agreement in risk categorisation with different prediction
models was compared using Cohen’s kappa coefficient(κ). Results 169
patients (females 130(81.1%)) mean age 65 ±6.9 years were studied.
80(47.3%), 62(36.7%), 18(10.7%), and 16(9.5%) were predicted
high-risk by FRS BMI-based, FRS cholesterol-based, WHO/ISH
without-cholesterol and WHO/ISH with-cholesterol models, respectively.
Agreement between the two FRS models (κ = 0.736, p<0.0001) and
the two WHO/ISH models (κ = 0.804, p<0.0001) in stratifying
patients into high and low-risk groups, were “good”. However, the
agreements between, FRS BMI-based and WHO/ISH without-cholesterol models
(κ = 0.234, p<0.0001) and FRS cholesterol-based and WHO/ISH
with-cholesterol models (κ = 0.306, p<0.0001) were only
“fair”. Conclusion Cardiovascular risk predictions of FRS were higher
than WHO/ISH charts and the agreement in risk stratification was not
satisfactory in Sri Lankans. Therefore, different cardiovascular risk
prediction models should not be used interchangeably in the follow-up of
South Asians.