For the first time, scientists have developed a new risk score that can predict the 10-year risk of developing heart disease or having a stroke in persons aged 40 years or older in any world country.
The research is published in The Lancet Diabetes & Endocrinology journal, and was led by Dr Goodarz Danaei, Assistant Professor of Global Health at the Harvard T. H. Chan School of Public Health in Boston, USA.
Danaei and colleagues developed, validated, and evaluated the new score, called Globorisk, using data from eight cohort studies [1], including more than 50 000 participants. Unlike previous risk scores, Globorisk can be updated to fit local conditions and risk factor levels in different countries using routinely available information.
Dr Danaei explains, "Globorisk is an important advance in the field of global cardiovascular disease prevention. Until now, most prediction scores were developed using a single cohort study and were never validated for accuracy in national populations for low- and middle-income countries. Therefore, clinicians and public health policy makers in these countries were left without a reliable tool to predict cardiovascular risk in their patients, community, or country."[2]
Globorisk measures cardiovascular risk in individuals aged 40 or older by factoring in the person's smoking status, blood pressure, diabetes status, and total cholesterol level, whilst adjusting for the effects of sex and age on cardiovascular disease between countries.
The researchers recalibrated and applied their risk score to 11 countries from different world regions [3], using data from recent national health surveys to replace the average age-and-sex risk factor levels in each country and incorporating cardiovascular disease death rates for each age-and-sex group. They developed country-specific risk charts for predicting individuals' risk of cardiovascular disease (see figure 4 pages 7-14), and country-specific assessments of the 10-year cardiovascular disease burden (see figure 5 page 15).
They estimate that the proportion of people at high risk (10% or higher) of having a fatal heart attack or stroke within 10 years is higher in low- and middle-income countries (eg, China and Mexico) compared with high-income countries (eg, South Korea, Spain, and Denmark). For example, in China around a third of men and women (nearly 170 million aged between 40 and 84 years) have a high 10-year risk of dying from a cardiovascular event compared with only 5-10% of men and women in Spain and Denmark (see figure 5 page 15).
According to Dr Danaei, "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 towards the WHO target of 50% coverage of multidrug treatment and counselling for people aged 40 years and older at high risk of cardiovascular disease." [2]
Karel Moons from the Utrecht University Medical Center in the Netherlands and Ewoud Schuit from the same centre and from Stanford University in the USA, both authors of a linked Comment, say, "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." [2]
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NOTES TO EDITORS:
This study was funded by the US National Institutes of Health, UK Medical Research Council, and the Wellcome Trust.
[1] Atherosclerosis Risk in Communities, Cardiovascular Health Study, Framingham Heart Study original cohort, Framingham Heart Study offspring cohort, Honolulu Heart Program, Multiple Risk Factor Intervention Trial, Puerto Rico Heart Health Program, and Women's Health Initiative Clinical Trial.
[2] Quotes direct from authors and cannot be found in text of Article / Comment
[3] China, Czech Republic, Denmark, England, Iran, Japan, Malawi, Mexico, South Korea, Spain, and the USA.
Journal
The Lancet Diabetes & Endocrinology