NEW YORK (Reuters Health) – Researchers have developed a tool to identify individuals at high cardiovascular risk in Latin America and the Caribbean (LAC).
“Finally, there is a cardiovascular risk score specific for this region and it performs reasonably well and even better than global available scores,” Dr. Rodrigo Carrillo-Larco of Imperial College, London and Dr. Goodarz Danaei of Harvard TH Chan School of Public Health in Boston told Reuters Health by email.
“Primary prevention of cardiovascular diseases should be strengthened throughout LAC,” they said. “For a successful implementation of the new risk score, clinicians and other healthcare personnel, as well as community health workers, should be aware of (it) and have the resources to use it – for example, time to apply the score during the consultation, access to laboratory facilities for a more comprehensive evaluation, and clear pathways to refer or start treatment according to local guidelines.”
“Future work should identify the best and most sustainable ways to implement this tool in standard clinical practice, and how to expand treatment coverage amongst those at high cardiovascular risk,” they added. “Guidelines, both globally and in LAC, should acknowledge this new risk score for LAC, and suggest its use for populations in LAC.”
As reported in The Lancet Regional Health – Americas, Drs. Carrillo-Larco, Danaei and colleagues developed a cardiovascular disease (CVD) risk score – including coronary heart disease and stroke risk – for fatal/non-fatal events using pooled data from nine prospective cohorts with a total of 21,378 patients (mean age, about 54; about 2/3 men).
At baseline, women had higher body mass index (28.7 kg/m2 vs. 26.1 kg/m2), and higher diabetes prevalence (11.5% vs.9.2%); by contrast, men were more likely to be smokers (39.1% vs. 20.9%).
During a mean follow-up of 8.5 years, 461 first non-fatal events and 741 fatal events not preceded by a non-fatal event occurred (incidence rate of composite outcome = 6.6).
Using these data, laboratory- and office-based models were developed.
In the laboratory-based model, higher systolic blood pressure (SBP), higher total cholesterol, diabetes and smoking were strongly associated with CVD risk.
In the office-based model, higher SBP and smoking were strongly associated with CVD risk. In both models, the association between SBP and cardiovascular events decreased with age.
The C-statistic for the laboratory-based model was 72%, and the calibration slope was 0.994 among men and 0.852 among women. For the office-based model, the C-statistic was 71% and the calibration slope was 1.028 among men and 0.811 among women.
In the pooled sample, using a 20% risk threshold, the laboratory-based model had sensitivity of 21.9% and specificity of 94.2%. Lowering the threshold to 10% increased sensitivity to 52.3% and reduced specificity to 78.7%.
Overall, the CVD risk score, called Globorisk-LAC, had adequate discrimination and calibration.
The authors conclude, “This work provides a tool to strengthen risk-based cardiovascular prevention.”
Dr. Carlos Alviar, a cardiologist and assistant professor of medicine at NYU Langone Health in New York City, commented on the tool in an email to Reuters Health, “This is a simple and easy to apply, well validated score that so far represents the only validated risk assessment tool for LAC patients. I think this can be very useful for clinicians and opens the opportunity for further research in the area.”
However, he said, “There is nothing specific about this particular score that will tailor it to LAC participants, but it is very important that it was specifically tested in the region. Clustering all Latin American participants in only one risk score is challenging, given that the region per se might have substantial differences between countries related to ethnic background as well as socioeconomic and cultural aspects that might influence cardiovascular risks, so perhaps including specific variables to adjust for this might be useful.”
Additional research directions, he added, could “include country-specific or sub-region-specific variables, such as genetic background, income, level of education, access to healthy food, etc.”
SOURCE: https://bit.ly/3vWLZcR Lancet Regional Health – Americas, online April 23, 2022
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