The Department of Endocrinology, 
Comparison of the performance of cardiovascular risk prediction tools in rural India: the Rishi Valley Prospective Cohort Study.
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 5, Block E, Monash Medical Centre, 246 Clayton Road, Melbourne, Victoria 3168, Australia.
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria, Australia.
- Pre-clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia.
- Faculty of Medicine, School of Population Health, University of New South Wales, Sydney, Australia.
- George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
- George Institute for Global Health, New Delhi, India.
- Rishi Valley Rural Health Centre, Madanapalle, Chittoor District, Andhra Pradesh, India.
- Department of Global Health and Population and Epidemiology, Harvard University T H Chan School of Public Health, Boston, MA, USA.
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
- Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia.
- National Centre for Healthy Ageing, Monash University and Peninsual Health, Melbourne, Victoria, Australia.
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India.
European journal of preventive cardiology Vol. 31 · Issue 6 · pp. 723-731
PMID 38149975 DOI 10.1093/eurjpc/zwad404
Cite This Article
Mulugeta Molla Birhanu, Ayse Zengin, Roger G Evans, Rohina Joshi, Kartik Kalyanram, Kamakshi Kartik, Goodarz Danaei, Elizabeth Barr, Michaela A Riddell, Oduru Suresh, Velandai K Srikanth, Simin Arabshahi, Nihal Thomas, Amanda G Thrift. Comparison of the performance of cardiovascular risk prediction tools in rural India: the Rishi Valley Prospective Cohort Study. European journal of preventive cardiology. 2024;31(6):723-731. doi:10.1093/eurjpc/zwad404
Abstract
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.
Keywords
- Cardiovascular disease
- Epidemiology
- Low- and middle-income countries
- Prevention
- Risk prediction
- Risk score
