Study Assesses New CVD Risk Score in National Populations

A patient's 10-year fatal cardiovascular disease risk can now be evaluated in any country in the world using a newly developed risk prediction equation, Globorisk, according to a study published March 25 in The Lancet Diabetes and Endocrinology. Further, the new risk score revealed high variations of risk between high-income and low-income countries.

Using data from eight prospective cohort studies, researchers sought to develop and utilize a risk prediction equation that could be recalibrated for use in different countries. The study included 50,129 participants aged 40 and above, who did not have a history of coronary heart disease or stroke, and were not missing data on smoking, blood pressure, diabetes and total cholesterol – factors integrated into the risk equation. Researchers also adjusted the risk score for the effects of sex and age. After developing risk equations for both fatal cardiovascular disease and for fatal plus non-fatal cardiovascular disease, researchers used the score to estimate the cardiovascular disease risk in 11 different countries, including China, Spain, Denmark and South Korea.

Results from the Globorisk score showed that only 5 – 10 percent of men and women in South Korea, Spain and Denmark had more than a 10 percent risk of cardiovascular disease, compared to 33 percent of men and 28 percent of women in China with similar risk. The authors report that "a non-smoking 65 year old man with diabetes, a systolic blood pressure of 140 mm Hg, and a total cholesterol of 6 mmol/L would have an estimated 10-year risk of fatal cardiovascular disease of 5 percent in Japan versus 24 percent in China."

Further, the cardiovascular disease risk estimation results suggested that there is a greater percentage of people in low- and middle-income countries with high cardiovascular disease risk compared to those in high-income countries.

According to the study's lead author, Goodarz Danaei, MD, assistant professor of Global Health at the Harvard T. H. Chan School of Public Health in Boston, "Globorisk can be used to identify individuals at high risk of developing cardiovascular disease who are most likely to benefit from lifestyle changes or preventive drug treatment. Moreover, by estimating the number of people who have a high risk in any given country we have more chance of accurately measuring progress toward the World Health Organization's target of 50 percent coverage of multi-drug treatment and counselling for people aged 40 years and older at high risk of cardiovascular disease."

In a related editorial comment, Karel Moons from the Utrecht University Medical Center in the Netherlands and Ewoud Schuit from Stanford University, explain that, "A next step would be to quantify the effects, on a population level, of introducing in these countries the Globorisk model combined with subsequent risk-based preventative management. These quantifications might further help, and indeed convince, decision-makers across the world to decide on wide-scale introduction of prediction models and risk-based management for cardiovascular disease."

Clinical Topics: Dyslipidemia, Prevention, Lipid Metabolism, Nonstatins, Smoking

Keywords: Blood Pressure, China, Cholesterol, Coronary Disease, Developed Countries, Diabetes Mellitus, Global Health, Income, Japan, Life Style, Netherlands, Prospective Studies, Public Health, Smoking, Stroke

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