Cardiovascular disease risk prediction in sub-Saharan African populations — Comparative analysis of risk algorithms in the RODAM study
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Date
2017
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Abstract
Background: Validated absolute risk equations are currently recommended as the basis of cardiovascular disease
(CVD) risk stratification in prevention and control strategies. However, there is no consensus on appropriate
equations for sub-Saharan African populations. We assessed agreement between different cardiovascular risk
equations among Ghanaian migrant and home populations with no overt CVD.
Methods: The 10-year CVD risks were calculated for 3586 participants aged 40–70 years in the multi-centre
RODAM study among Ghanaians residing in Ghana and Europe using the Framingham laboratory and
non laboratory and Pooled Cohort Equations (PCE) algorithms. Participants were classified as low, moderate or
high risk, corresponding to b10%, 10–20% and N20% respectively. Agreement between the risk algorithms was
assessed using kappa and correlation coefficients.
Results: 19.4%, 12.3% and 5.8% were ranked as high 10-year CVD risk by Framingham non-laboratory,
Framing ham laboratory and PCE, respectively. The median (25th–75th percentiles) estimated 10-year CVD risk
was9.5% (5.4–15.7), 7.3% (3.9–13.2) and 5.0% (2.3–9.7) for Framingham non-laboratory, Framingham laboratory
and PCE, respectively. The concordance between PCE and Framingham non-laboratory was better in the home
Ghanaian population (kappa = 0.42, r = 0.738) than the migrant population (kappa = 0.24, r = 0.732) whereas
concordance between PCE and Framingham laboratory was better in migrant Ghanaians (kappa = 0.54, r =
0.769) than the home population (kappa = 0.51, r = 0.758).
Conclusion: CVD prediction with the same algorithm differs for the migrant and home populations and the
inter changeability of Framingham laboratory and non-laboratory algorithms is limited. Validation against CVD
outcomes is needed to inform appropriate selection of risk algorithms for use in African ancestry populations
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This article is published by Elsevier and is also available at www.elsevier.com/locate/ijcard
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Citation
International Journal of Cardiology 254 (2018) 310–315