Comparison of World Health Organization/International Society of Hypertension Risk Charts and the Framingham Risk Score for Cardiovascular Risk Prediction in Primary Care, Gharbia Governorate, Egypt

Background: Assessment of cardiovascular disease (CVD) risk is essential for prevention and early detection. The Framingham Risk Score (FRS) is one of the most widely used tools for risk estimation. In contrast, the World Health Organization/International Society of Hypertension (WHO-ISH) risk charts were specifically developed to provide region-specific cardiovascular risk estimates. Aim: To compare the risk of 10‑year CVD predictions by the FRS with charts of WHO-ISH risk among adults attending primary care facilities. Methods: A cross-sectional study was conducted between March 2024 and 2025 in randomly selected healthcare facilities in Gharbia, Egypt. A total of 160 adults aged 40 years or older without established cardiovascular disease were included. Participants underwent clinical examination, anthropometric assessment, and laboratory testing. Cardiovascular risk was estimated using both FRS and WHO/ISH charts, and agreement between the methods was assessed using weighted kappa statistics. Results: The participants had a mean age of 54.8 ± 10.2 years; 72.5%. Hypertension (35.6%) and diabetes (22.5%) were the most prevalent comorbidities. FRS classified 32.5% as low risk, while WHO/ISH cholesterol‑based and non‑laboratory charts identified 30.6% and 21.3% as high risk, respectively. Agreement between the different tools was generally strong; excellent agreement was observed between FRS and WHO/ISH cholesterol charts (weighted κ = 0.86), whereas agreement was moderate for both FRS versus non-laboratory charts (κ = 0.66) and between the two WHO/ISH chart versions (κ = 0.68). Conclusion: WHO/ISH charts incorporating cholesterol have strong agreement with the FRS, while the non-laboratory charts show only moderate concordance. These findings indicate agreement between tools rather than predictive accuracy.