Key result
Non-laboratory WHO CVD risk charts show ~83% concordance with laboratory-based charts.
Why the study?
Non-laboratory-based WHO CVD risk charts were developed for resource-limited settings, but their concordance with laboratory-based charts in rural Indian populations was unclear.
Does the non-laboratory-based WHO CVD risk chart accurately estimate cardiovascular risk compared to the laboratory-based chart in a rural Indian population?
Cross-Sectional (n=1,018)
No
Does the non-laboratory-based WHO CVD risk chart accurately estimate cardiovascular risk compared to the laboratory-based chart in a rural Indian population?
Effect estimate: kappa 0.64
Non-laboratory-based WHO CVD risk charts show good agreement with laboratory-based charts, making them a reliable and practical tool for CVD risk estimation in resource-limited settings.
Substantial agreement supports interchangeable WHO non-lab charts in resource-limited settings; leaves open prospective outcome validation.
Introduction: Timely, affordable, and sustained interventions reduce the risk of heart attack or Stroke in people with a high total risk of cardiovascular diseases (CVD). Risk prediction tools are available to estimate the cardiovascular risk using information on multiple variables. CVD risk charts prepared by the World Health Organization (WHO) has laboratory-based and non-laboratory-based charts with the latter meant for use in resource limited settings. We conducted a study to determine concordance between the laboratory- and non-laboratory risk charts and to estimate the prevalence of selected CVD risk factors in a rural Indian population. Methods: A community-based cross-sectional study was conducted in rural area of Ballabgarh in district Faridabad, Haryana. Sample of 1,018 participants aged 30-69 years was selected randomly from study area. Information on CVDs risk factors was obtained using WHO STEPS questionnaire, anthropometry and laboratory investigation. Risk distribution among the study participants was observed. Concordance between laboratory- and non-laboratory-based WHO CVD risk charts was determined using agreement analysis. Results: The mean age of the study participants was 43.9 (8.9) years and 55.6% participants were women. Among various CVD risk factors, hypertension (39.4%) was the major factor followed by overweight (34.1%) was found to be major factor, followed by current smoking (23.6%) and hypercholesterolemia (18.7%). The concordance between the two charts was 83.3% with kappa value of 0.64. Considering laboratory-based charts as the gold standard, the sensitivity and specificity of non-laboratory-based risk charts at 5% risk as cut-off was 86.5% and 90.3% respectively. Conclusion: The study shows a good agreement between the laboratory-based and non-laboratory-based risk charts. Thus non-laboratory-based risk charts are suitable for risk estimation of CVDs for use in resource limited settings like India.
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Das et al. (2022) conducted a cross-sectional in Cardiovascular disease risk (n=1,018). Non-laboratory-based WHO CVD risk charts vs. Laboratory-based WHO CVD risk charts was evaluated on Concordance between laboratory- and non-laboratory-based WHO CVD risk charts (kappa 0.64). Non-laboratory-based WHO CVD risk charts demonstrated 83.3% concordance (kappa 0.64) with laboratory-based charts, yielding 86.5% sensitivity and 90.3% specificity at a 5% risk cut-off.
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