Key result
Globorisk tools demonstrate the best discrimination for 5-year CV events in rural India.
Why the study?
The performance of cardiovascular risk prediction tools had not been well characterized in rural India.
How do cardiovascular risk prediction tools (WHO-RS, ARS, Globorisk) perform in predicting 5-year cardiovascular events in adults without prior CVD in rural India?
Cohort (n=2,333)
How do cardiovascular risk prediction tools (WHO-RS, ARS, Globorisk) perform in predicting 5-year cardiovascular events in adults without prior CVD in rural India?
Effect estimate: C-statistic 0.68-0.69
p-value: p=0.003
The Globorisk tool demonstrated the best predictive performance for 5-year cardiovascular events in a rural Indian cohort, and adding clinical criteria to a 10% risk threshold improved diagnostic accuracy.
May inform CV risk stratification in rural India; leaves open prospective validation before clinical adoption.
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 χ2: 26.5, P = 0.003) and non-laboratory-based (C-statistic: 0.69 and χ2: 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.
No takes yet. Share an insight, caveat, or question.
Birhanu et al. (2023) conducted a cohort in Without prior cardiovascular disease (n=2,333). Cardiovascular risk prediction tools (WHO-RS, ARS, Globorisk) was evaluated on Cardiovascular events during 5-year follow-up (C-statistic 0.68-0.69, p=0.003). The Globorisk cardiovascular risk prediction tools demonstrated the best discrimination for 5-year cardiovascular events in rural India (C-statistic 0.68-0.69, P=0.003).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: