TY - JOUR
T1 - Atherosclerotic cardiovascular disease risk among Ghanaians
T2 - A comparison of the risk assessment tools.
AU - Agyekum, Francis
AU - Akumiah, Florence Koryo
AU - Nguah, Samuel Blay
AU - Appiah, Lambert Tetteh
AU - Ganatra, Khushali
AU - Adu-Boakye, Yaw
AU - Folson, Aba Ankomaba
AU - Ayetey, Harold
AU - Owusu, Isaac Kofi
N1 - Publisher Copyright:
© 2024 The Author(s)
PY - 2024/6
Y1 - 2024/6
N2 - Objectives: Risk stratification is a cornerstone for preventing atherosclerotic cardiovascular disease (ASCVD). Ghana has yet to develop a locally derived and validated ASCVD risk model. A critical first step towards this goal is assessing how the commonly available risk models perform in the Ghanaian population. This study compares the agreement and correlation between four ASCVD risk assessment models commonly used in Ghana. Methods: The Ghana Heart Study collected data from four regions in Ghana (Ashanti, Greater Accra, Northern, and Central regions) and excluded people with a self-declared history of ASCVD. The 10-year fatal/non-fatal ASCVD risk of participants aged 40–74 was calculated using mobile-based apps for Pooled Cohort Equation (PCE), laboratory-based WHO/ISH CVD risk, laboratory-based Framingham risk (FRS), and Globorisk, categorizing them as low, intermediate, or high risk. The risk categories were compared using the Kappa statistic and Spearman correlation. Results: A total of 615 participants were included in this analysis (median age 55 [Inter quartile range 46, 64]) years with 365 (59.3 %) females. The WHO/ISH risk score categorized 504 (82.0 %), 58 (9.4 %), and 53 (8.6 %) as low-, intermediate-, and high-risk, respectively. The PCE categorized 345 (56.1 %), 181 (29.4 %), and 89 (14.5 %) as low-, intermediate- and high-risk, respectively. The Globorisk categorized 236 (38.4 %), 273 (44.4 %), and 106 (17.2 %) as low-, intermediate-, and high-risk, respectively. Significant differences in the risk categorization by region of residence and age group were noted. There was substantial agreement between the PCE vs FRS (Kappa = 0.8, 95 % CI 0.7 – 0.8), PCE vs Globorisk (Kappa = 0.6; 95 % CI 0.6 – 0.7), and FRS vs Globorisk (Kappa = 0.6; 95 % CI 0.6 – 0.7). However, there was only fair agreement between the WHO vs Globorisk (Kappa = 0.3; 95 % CI 0.3–0.4) and moderate agreement between the WHO vs PCE and WHO vs FRS. Conclusion: There are significant differences in the ASCVD risk prediction tools in the Ghanaian population, posing a threat to primary prevention. Therefore, there is a need for locally derived and validated tools.
AB - Objectives: Risk stratification is a cornerstone for preventing atherosclerotic cardiovascular disease (ASCVD). Ghana has yet to develop a locally derived and validated ASCVD risk model. A critical first step towards this goal is assessing how the commonly available risk models perform in the Ghanaian population. This study compares the agreement and correlation between four ASCVD risk assessment models commonly used in Ghana. Methods: The Ghana Heart Study collected data from four regions in Ghana (Ashanti, Greater Accra, Northern, and Central regions) and excluded people with a self-declared history of ASCVD. The 10-year fatal/non-fatal ASCVD risk of participants aged 40–74 was calculated using mobile-based apps for Pooled Cohort Equation (PCE), laboratory-based WHO/ISH CVD risk, laboratory-based Framingham risk (FRS), and Globorisk, categorizing them as low, intermediate, or high risk. The risk categories were compared using the Kappa statistic and Spearman correlation. Results: A total of 615 participants were included in this analysis (median age 55 [Inter quartile range 46, 64]) years with 365 (59.3 %) females. The WHO/ISH risk score categorized 504 (82.0 %), 58 (9.4 %), and 53 (8.6 %) as low-, intermediate-, and high-risk, respectively. The PCE categorized 345 (56.1 %), 181 (29.4 %), and 89 (14.5 %) as low-, intermediate- and high-risk, respectively. The Globorisk categorized 236 (38.4 %), 273 (44.4 %), and 106 (17.2 %) as low-, intermediate-, and high-risk, respectively. Significant differences in the risk categorization by region of residence and age group were noted. There was substantial agreement between the PCE vs FRS (Kappa = 0.8, 95 % CI 0.7 – 0.8), PCE vs Globorisk (Kappa = 0.6; 95 % CI 0.6 – 0.7), and FRS vs Globorisk (Kappa = 0.6; 95 % CI 0.6 – 0.7). However, there was only fair agreement between the WHO vs Globorisk (Kappa = 0.3; 95 % CI 0.3–0.4) and moderate agreement between the WHO vs PCE and WHO vs FRS. Conclusion: There are significant differences in the ASCVD risk prediction tools in the Ghanaian population, posing a threat to primary prevention. Therefore, there is a need for locally derived and validated tools.
KW - ASCVD
KW - Atherosclerotic cardiovascular disease
KW - Cardiovascular risk
KW - Ghana
KW - Risk scores
UR - http://www.scopus.com/inward/record.url?scp=85190613824&partnerID=8YFLogxK
U2 - 10.1016/j.ajpc.2024.100670
DO - 10.1016/j.ajpc.2024.100670
M3 - Article
AN - SCOPUS:85190613824
SN - 2666-6677
VL - 18
JO - American Journal of Preventive Cardiology
JF - American Journal of Preventive Cardiology
M1 - 100670
ER -