Cardiovascular Risk Assessment among Adults in Primary Health Care Settings in Sulaimani Using WHO Risk Prediction Charts
https://doi.org/10.24017/science.2018.2.25
Abstract views: 1276 / PDF downloads: 760Abstract
WHO adopted World Health Organization/International Society of Hypertension (WHO/ISH) risk charts to predict cardiovascular disease risk in low and middle income countries. The aim of this study was to estimate the cardiovascular risk in adults ?40 years old by using the two versions of the WHO/ISH risk prediction charts “with and without cholesterol”, and to find out the risk by other parameters not found in the chart; also, to evaluate concordance between the two approaches. A cross-sectional study was conducted from August 2016 to February 2017 in two primary health care centers in Sulaimani City among 500 persons aged 40-82 years. The desired information was collected by using a pretested questionnaire; anthropometric measurements and laboratory investigations were also carried out for the participants. Cardiovascular risk was assessed by the WHO/ISH risk prediction charts for the Eastern Mediterranean region in category D. Mean age of the participants was 52.5(±9.55) years and 70.4% of the participants were females. Only 260 participants had the results of total cholesterol and triglycerides. The results revealed that, using the risk assessment charts with and without cholesterol, 22.3% and 19.2% respectively of the study population were in the ten-year cardiovascular risk category of ?20%. Risk categories were concordant in 86.2% of the population; and when we applied single risk factor approach 51.5% would require drug treatment. The WHO/ISH risk chart is an affordable and simple tool to estimate cardiovascular disease risk. Nearly one fifth of adults aged ? 40 years in Sulaimani City are at high-very high risk of developing cardiovascular event in the next ten years as assessed by WHO/ISH risk prediction charts. The use of the without cholesterol version of the chart to estimate cardiovascular disease risk could be useful is settings where cholesterol cannot be measured.
Keywords:
World Health Organization/International Society of Hypertension (WHO/ISH) risk chart, Cardiovascular risk assessment, Primary health care centers, Sulaimani City.
References
[1] World Health Organization. "Prevention of cardiovascular disease: Guidelines for assessment and management of cardiovascular risk," Geneva, WHO, 2007.
[2] DO. Abegunde, CD. Mathers, T. Adam, M. Ortegon, K. Strong, "The burden and costs of chronic diseases in low-income and middle-income countries," Lancet; 370 (9603), pp. 1929-38, 2007.
https://doi.org/10.1016/S0140-6736(07)61696-1
[3] American Heart Association, "Heart Disease and Stroke Statistics - At-a-Glance" onebraveidea.com, Jan. 25, 2017 [Online]. Available: http://www.onebraveidea.com/submissions/ucm_470704.pdf. [Accessed: 2017].
[4] World Health Organization, "World Heart Federation, World Stroke Organization," Global Atlas on cardiovascular disease prevention and control, 2011.
[5] World Health Organization, "The global burden of disease 2004 update, 2008.
[6] Heart Information Center, "Heart Anatomy, www.texasheart.org August 2016 [Online]. Available:http://www.texasheart.org/HIC/Anatomy/anatomy2.cfm. [Accessed: 2016].
[7] BA. Raphael, AA. Ernest, A. Charles, "Chronic Non-Communicable Diseases in Low and Middle-income," 2016.
[8] World Health Organization, "Global Health Risks: Mortality and Burden of Disease Attributable to Selected Major Risks," 2009.
[9] R. Jackson, CM. Lawes, DA. Bennett, RJ. Minle, A. Rodgers, "Treatment with drugs to lower blood pressure and blood cholesterol based on an individual's absolute cardiovascular risk," Lancet, 365(9457), pp. 434-41, 2005.
https://doi.org/10.1016/S0140-6736(05)70240-3
[10] WB. Kannel, D. McGee, "Diabetes and glucose tolerance as risk factors for cardiovascular disease: the Framingham study," Diabetes Care, 2(2), pp. 120-6, 1979.
https://doi.org/10.2337/diacare.2.2.120
[11] S. Mendis, L.H. Lindholm, G. Mancia, J. Whitworth, M. Alderman, S. Lim, et al., "World Health Organization (WHO) and International Society of Hypertension (ISH) risk prediction charts: assessment of cardiovascular risk for prevention and control of cardiovascular disease in low and middle-income countries," J Hypertens, 25 (8), pp. 1578-1582, 2007.
https://doi.org/10.1097/HJH.0b013e3282861fd3
[12] RB. Agostino, RS. Vasan, MJ. Pencina, PA. Wolf, M. Cobain, JM. Massaro, et al., "General cardiovascular risk profile for use in primary care: the Framingham Heart Study," Circulation, 117(6), pp. 743-53, 2008.
https://doi.org/10.1161/CIRCULATIONAHA.107.699579
[13] XF. Zhang, J. Attia, C. D'Este, XH. Yu, XG. Wu, "A risk score predicted coronary heart disease and stroke in a Chinese cohort," J Clin Epidemiol, 58(9), pp. 951-82005.
https://doi.org/10.1016/j.jclinepi.2005.01.013
[14] World Health Organization, "Prevention of Cardiovascular Disease: Pocket guidelines with cardiovascular risk prediction charts for assessment and management of cardiovascular risk," 2007.
[15] K. Fatema, NA. Zwar, AH. Milton, B. Rahman, L. Ali, "Application of two versions of the WHO/international society of hypertension absolute cardiovascular risk assessment tools in a rural Bangladeshi population," BMJ Open, 5(10), pp. 10, 2015.
https://doi.org/10.1136/bmjopen-2015-008140
[16] JA. Batsis, F. Lopes- Jimenez, "Cardiovascular risk assessment - From individual risk prediction to estimation of global risk and change in risk in the population," BMC Medicine, 29 (8), pp.12, 2010.
https://doi.org/10.1186/1741-7015-8-29
[17] World Health Organization, "WHO/ISH Risk prediction charts for 14 WHO epidemiological sub-regions, ish-world.com, Nov. 19, 2014. [Online]. Available: http://ish-world.com/downloads/activities/colour_charts_24_ Aug_07.pdf. [Accessed: 2007].
[18] World Health Organization, "Iraq: WHO statistical profile," who.int, Jan 2015. [Online]. Available: http://www.who.int/gho/countries/irq.pdf. [Accessed: 2012].
[19] World Health Organization, "International Society of Hypertension. Cardiovascular risk prediction charts: strengths and limitations," who.int, Feb. 2012. [Online]. Available: http://www.who.int/cardiovascular_diseases/publications/cvd_qa.pdf?ua=1. [Accessed: 2013.
[20] World Health Organization, "Definition and Diagnosis of Diabetes Mellitus and Intermediate Hyperglycemia," 2006.
[21] Mayo Clinic, "Type 2 diabetes Diagnosis," mayoclinic.org, Aug. 23. 2017 [Online]. Available: http://www.mayoclinic.org/diseases-conditions/type-2-diabetes/diagnosis-treatment /diagnosis/dxc-20169894. [Accessed: 2017].
[22] World Health Organization, "Waist circumference and waist-hip ratio," 2008.
[23] S. Mendis, LH. Lindholm, SG. Anderson, A. Alwan, R. Koju, BJ, Onwubere. et al., "Total cardiovascular risk approach to improve efficiency of cardiovascular prevention in resource constrain settings," J Clin Epidemiol, 64(12), pp. 1451-62, 2011.
https://doi.org/10.1016/j.jclinepi.2011.02.001
[24] MK. Khanal, M. Ahmed, M. Moniruzzaman, PC. Banik, RR. Dhungana, P. Bhandari, et al., "Total cardiovascular risk for next 10 years among rural population of Nepal using WHO/ISH risk prediction chart," BMC Res Notes, 10(1), pp. 120-8, 2017.
https://doi.org/10.1186/s13104-017-2436-9
[25] S. Otgontuya, BS. Oum, R. Buckley, "Assessment of total cardiovascular risk using WHO/ISH risk prediction charts in three low and middle income countries in Asia," BMC Public Health, 539 (13), pp. 312-24, 2013.
https://doi.org/10.1186/1471-2458-13-539
[26] GA. Ghorpade, SR. Shrivastava, SS. Kar, S. Sarkar, SM. Majidi, G. Roy, "Estimation of the cardiovascular risk using World Health Organization/International Society of Hypertension (WHO/ISH) risk prediction charts in a rural population of South India," Int J Health Policy Manag, 4(8), pp. 531-36, 2015.
https://doi.org/10.15171/ijhpm.2015.88
[27] Stockholm International Peace Research Institute. World Diabetes Day - Diabetes in conflict areas sipri.org, Jul. 2012. [Online]. Available: https://www.sipri.org/commentary/blog/2012/world-diabetes-day-diabetes-conflict-areas. [Accessed: 2012].
[28] A. Mansour, F. Al Douri, "Diabetes in Iraq: Facing the Epidemic. A systematic Review," Wulfenia Journal, 22(3), pp. 258-73, 2015.
[29] M. Abd Elaziz, SA. Dewedar, S. Sabbour, MM. El Gafaary, DM. Marzouk, A. Aboul Fotouh, et al., "Screening for hypertension among adults: community outreach in Cairo," Egypt. J Public Health (Oxf), 37(4), pp. 701-6, 2014.
https://doi.org/10.1093/pubmed/fdu085
[30] AN. Shukla, T. Madan, BM. Thakkar, MM. Parmar, KH. Shah, "Prevalence and Predictors of Undiagnosed Hypertension in an Apparently Healthy Western Indian Population," Adv Epidemiol.(Hindawi), 5(4), pp. 6491-8, 3015.
[31] P. Nordet, S. Mendis, A. Dueñas, R. de la Noval, N. Armas, IL. de la Noval, et al., "Total cardiovascular risk assessment and management using two prediction tools, with and without blood cholesterol," MEDICC Rev, 15(4), pp. 36-40, 2013.
https://doi.org/10.37757/MR2013V15.N4.9
[32] BB. Green, ML. Anderson, AJ. Cook, S. Catz, PA. Fishman, JB. McClure, et al., "Using body mass index data in the electronic health record to calculate cardiovascular risk," Am J Prev Med, 42(4), pp. 342-7, 2012.
https://doi.org/10.1016/j.amepre.2011.12.009
[2] DO. Abegunde, CD. Mathers, T. Adam, M. Ortegon, K. Strong, "The burden and costs of chronic diseases in low-income and middle-income countries," Lancet; 370 (9603), pp. 1929-38, 2007.
https://doi.org/10.1016/S0140-6736(07)61696-1
[3] American Heart Association, "Heart Disease and Stroke Statistics - At-a-Glance" onebraveidea.com, Jan. 25, 2017 [Online]. Available: http://www.onebraveidea.com/submissions/ucm_470704.pdf. [Accessed: 2017].
[4] World Health Organization, "World Heart Federation, World Stroke Organization," Global Atlas on cardiovascular disease prevention and control, 2011.
[5] World Health Organization, "The global burden of disease 2004 update, 2008.
[6] Heart Information Center, "Heart Anatomy, www.texasheart.org August 2016 [Online]. Available:http://www.texasheart.org/HIC/Anatomy/anatomy2.cfm. [Accessed: 2016].
[7] BA. Raphael, AA. Ernest, A. Charles, "Chronic Non-Communicable Diseases in Low and Middle-income," 2016.
[8] World Health Organization, "Global Health Risks: Mortality and Burden of Disease Attributable to Selected Major Risks," 2009.
[9] R. Jackson, CM. Lawes, DA. Bennett, RJ. Minle, A. Rodgers, "Treatment with drugs to lower blood pressure and blood cholesterol based on an individual's absolute cardiovascular risk," Lancet, 365(9457), pp. 434-41, 2005.
https://doi.org/10.1016/S0140-6736(05)70240-3
[10] WB. Kannel, D. McGee, "Diabetes and glucose tolerance as risk factors for cardiovascular disease: the Framingham study," Diabetes Care, 2(2), pp. 120-6, 1979.
https://doi.org/10.2337/diacare.2.2.120
[11] S. Mendis, L.H. Lindholm, G. Mancia, J. Whitworth, M. Alderman, S. Lim, et al., "World Health Organization (WHO) and International Society of Hypertension (ISH) risk prediction charts: assessment of cardiovascular risk for prevention and control of cardiovascular disease in low and middle-income countries," J Hypertens, 25 (8), pp. 1578-1582, 2007.
https://doi.org/10.1097/HJH.0b013e3282861fd3
[12] RB. Agostino, RS. Vasan, MJ. Pencina, PA. Wolf, M. Cobain, JM. Massaro, et al., "General cardiovascular risk profile for use in primary care: the Framingham Heart Study," Circulation, 117(6), pp. 743-53, 2008.
https://doi.org/10.1161/CIRCULATIONAHA.107.699579
[13] XF. Zhang, J. Attia, C. D'Este, XH. Yu, XG. Wu, "A risk score predicted coronary heart disease and stroke in a Chinese cohort," J Clin Epidemiol, 58(9), pp. 951-82005.
https://doi.org/10.1016/j.jclinepi.2005.01.013
[14] World Health Organization, "Prevention of Cardiovascular Disease: Pocket guidelines with cardiovascular risk prediction charts for assessment and management of cardiovascular risk," 2007.
[15] K. Fatema, NA. Zwar, AH. Milton, B. Rahman, L. Ali, "Application of two versions of the WHO/international society of hypertension absolute cardiovascular risk assessment tools in a rural Bangladeshi population," BMJ Open, 5(10), pp. 10, 2015.
https://doi.org/10.1136/bmjopen-2015-008140
[16] JA. Batsis, F. Lopes- Jimenez, "Cardiovascular risk assessment - From individual risk prediction to estimation of global risk and change in risk in the population," BMC Medicine, 29 (8), pp.12, 2010.
https://doi.org/10.1186/1741-7015-8-29
[17] World Health Organization, "WHO/ISH Risk prediction charts for 14 WHO epidemiological sub-regions, ish-world.com, Nov. 19, 2014. [Online]. Available: http://ish-world.com/downloads/activities/colour_charts_24_ Aug_07.pdf. [Accessed: 2007].
[18] World Health Organization, "Iraq: WHO statistical profile," who.int, Jan 2015. [Online]. Available: http://www.who.int/gho/countries/irq.pdf. [Accessed: 2012].
[19] World Health Organization, "International Society of Hypertension. Cardiovascular risk prediction charts: strengths and limitations," who.int, Feb. 2012. [Online]. Available: http://www.who.int/cardiovascular_diseases/publications/cvd_qa.pdf?ua=1. [Accessed: 2013.
[20] World Health Organization, "Definition and Diagnosis of Diabetes Mellitus and Intermediate Hyperglycemia," 2006.
[21] Mayo Clinic, "Type 2 diabetes Diagnosis," mayoclinic.org, Aug. 23. 2017 [Online]. Available: http://www.mayoclinic.org/diseases-conditions/type-2-diabetes/diagnosis-treatment /diagnosis/dxc-20169894. [Accessed: 2017].
[22] World Health Organization, "Waist circumference and waist-hip ratio," 2008.
[23] S. Mendis, LH. Lindholm, SG. Anderson, A. Alwan, R. Koju, BJ, Onwubere. et al., "Total cardiovascular risk approach to improve efficiency of cardiovascular prevention in resource constrain settings," J Clin Epidemiol, 64(12), pp. 1451-62, 2011.
https://doi.org/10.1016/j.jclinepi.2011.02.001
[24] MK. Khanal, M. Ahmed, M. Moniruzzaman, PC. Banik, RR. Dhungana, P. Bhandari, et al., "Total cardiovascular risk for next 10 years among rural population of Nepal using WHO/ISH risk prediction chart," BMC Res Notes, 10(1), pp. 120-8, 2017.
https://doi.org/10.1186/s13104-017-2436-9
[25] S. Otgontuya, BS. Oum, R. Buckley, "Assessment of total cardiovascular risk using WHO/ISH risk prediction charts in three low and middle income countries in Asia," BMC Public Health, 539 (13), pp. 312-24, 2013.
https://doi.org/10.1186/1471-2458-13-539
[26] GA. Ghorpade, SR. Shrivastava, SS. Kar, S. Sarkar, SM. Majidi, G. Roy, "Estimation of the cardiovascular risk using World Health Organization/International Society of Hypertension (WHO/ISH) risk prediction charts in a rural population of South India," Int J Health Policy Manag, 4(8), pp. 531-36, 2015.
https://doi.org/10.15171/ijhpm.2015.88
[27] Stockholm International Peace Research Institute. World Diabetes Day - Diabetes in conflict areas sipri.org, Jul. 2012. [Online]. Available: https://www.sipri.org/commentary/blog/2012/world-diabetes-day-diabetes-conflict-areas. [Accessed: 2012].
[28] A. Mansour, F. Al Douri, "Diabetes in Iraq: Facing the Epidemic. A systematic Review," Wulfenia Journal, 22(3), pp. 258-73, 2015.
[29] M. Abd Elaziz, SA. Dewedar, S. Sabbour, MM. El Gafaary, DM. Marzouk, A. Aboul Fotouh, et al., "Screening for hypertension among adults: community outreach in Cairo," Egypt. J Public Health (Oxf), 37(4), pp. 701-6, 2014.
https://doi.org/10.1093/pubmed/fdu085
[30] AN. Shukla, T. Madan, BM. Thakkar, MM. Parmar, KH. Shah, "Prevalence and Predictors of Undiagnosed Hypertension in an Apparently Healthy Western Indian Population," Adv Epidemiol.(Hindawi), 5(4), pp. 6491-8, 3015.
[31] P. Nordet, S. Mendis, A. Dueñas, R. de la Noval, N. Armas, IL. de la Noval, et al., "Total cardiovascular risk assessment and management using two prediction tools, with and without blood cholesterol," MEDICC Rev, 15(4), pp. 36-40, 2013.
https://doi.org/10.37757/MR2013V15.N4.9
[32] BB. Green, ML. Anderson, AJ. Cook, S. Catz, PA. Fishman, JB. McClure, et al., "Using body mass index data in the electronic health record to calculate cardiovascular risk," Am J Prev Med, 42(4), pp. 342-7, 2012.
https://doi.org/10.1016/j.amepre.2011.12.009
Downloads
How to Cite
[1]
V. Najim Edeen and Z. Salah Ramzi, “Cardiovascular Risk Assessment among Adults in Primary Health Care Settings in Sulaimani Using WHO Risk Prediction Charts”, KJAR, vol. 3, no. 2, pp. 150–155, Jul. 2018, doi: 10.24017/science.2018.2.25.
Published
23-07-2018
Issue
Section
Pure and Applied Science
