Comparative assessment of absolute cardiovascular disease risk characterization from non-laboratory-based risk assessment in South African populations.
Comparative assessment of absolute cardiovascular disease risk characterization from non-laboratory-based risk assessment in South African populations.
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DOI：
10.1186/1741-7015-11-170
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发表时间：
2013-07-24
期刊：
影响因子：
9.3
通讯作者：
Laubscher R
中科院分区：
文献类型：
--
作者：
Gaziano TA;Pandya A;Steyn K;Levitt N;Mollentze W;Joubert G;Walsh CM;Motala AA;Kruger A;Schutte AE;Naidoo DP;Prakaschandra DR;Laubscher R
所有严格的原发性心血管疾病 (CVD) 预防指南均建议采用绝对 CVD 风险评分来识别高风险和低风险患者，但实验室检测在低收入和中等收入国家可能不切实际。本研究的目的是比较南非不同人群中简单的非实验室风险评分与实验室评分的排名表现。我们计算并比较了来自南非 13 个横截面人口的 14,772 名成年人的 10 年 CVD（或冠心病 (CHD)）风险（数据收集于 1987 年至 2009 年）。通过使用 Spearman 等级相关性和同等特征为“高”或“低”风险的人口百分比，将风险排名与六个基于实验室的评分（Framingham 风险的三个版本、高风险和低风险国家的 SCORE 以及 CUORE）进行比较，评估非实验室评分的风险表征表现。还根据 1998 年南非人口健康调查（DHS，n = 9,379）的代表性横截面计算了 10 年非实验室 CVD 死亡总风险，以估计国家 CVD 死亡风险负担。非实验室评分与实验室评分的 Spearman 相关系数范围为 0.88 至 0.986。使用传统的 CVD 风险阈值（10% 至 20% 10 年 CVD 风险），使用非实验室和 Framingham (2008) CVD 风险评分，90% 至 92% 的男性和 94% 至 97% 的女性被同等地描述为“高”或“低”风险。这些结果在评估的 6 个风险评分和 13 个横截面数据集中都是稳健的，除了少数例外（非实验室风险评分与 Framingham (1991) CHD 风险评分之间的一致性较低）。使用非实验室评分，DHS 人群中约 18% 的成年人被描述为“高 CVD 风险”（10 年 CVD 死亡风险 >20%）。我们发现简单的、非实验室的 CVD 风险评分与常用的基于实验室的风险评分之间存在高度相关性。南非男性和女性的心血管疾病死亡风险负担很高。政策和临床意义是，与时间和资源密集型方法相比，快速、低成本的筛查工具可以产生类似的风险评估结果。在特定环境的队列研究能够得出并验证特定国家的风险评分之前，基于非实验室的 CVD 风险评估可能是南非一种有效且高效的主要 CVD 筛查方法。
All rigorous primary cardiovascular disease (CVD) prevention guidelines recommend absolute CVD risk scores to identify high- and low-risk patients, but laboratory testing can be impractical in low- and middle-income countries. The purpose of this study was to compare the ranking performance of a simple, non-laboratory-based risk score to laboratory-based scores in various South African populations. We calculated and compared 10-year CVD (or coronary heart disease (CHD)) risk for 14,772 adults from thirteen cross-sectional South African populations (data collected from 1987 to 2009). Risk characterization performance for the non-laboratory-based score was assessed by comparing rankings of risk with six laboratory-based scores (three versions of Framingham risk, SCORE for high- and low-risk countries, and CUORE) using Spearman rank correlation and percent of population equivalently characterized as ‘high’ or ‘low’ risk. Total 10-year non-laboratory-based risk of CVD death was also calculated for a representative cross-section from the 1998 South African Demographic Health Survey (DHS, n = 9,379) to estimate the national burden of CVD mortality risk. Spearman correlation coefficients for the non-laboratory-based score with the laboratory-based scores ranged from 0.88 to 0.986. Using conventional thresholds for CVD risk (10% to 20% 10-year CVD risk), 90% to 92% of men and 94% to 97% of women were equivalently characterized as ‘high’ or ‘low’ risk using the non-laboratory-based and Framingham (2008) CVD risk score. These results were robust across the six risk scores evaluated and the thirteen cross-sectional datasets, with few exceptions (lower agreement between the non-laboratory-based and Framingham (1991) CHD risk scores). Approximately 18% of adults in the DHS population were characterized as ‘high CVD risk’ (10-year CVD death risk >20%) using the non-laboratory-based score. We found a high level of correlation between a simple, non-laboratory-based CVD risk score and commonly-used laboratory-based risk scores. The burden of CVD mortality risk was high for men and women in South Africa. The policy and clinical implications are that fast, low-cost screening tools can lead to similar risk assessment results compared to time- and resource-intensive approaches. Until setting-specific cohort studies can derive and validate country-specific risk scores, non-laboratory-based CVD risk assessment could be an effective and efficient primary CVD screening approach in South Africa.
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