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Cai Y, Cai YQ, Tang LY, Wang YH, Gong M, Jing TC, Li HJ, Li-Ling J, Hu W, Yin Z, Gong DX, Zhang GW. Artificial intelligence in the risk prediction models of cardiovascular disease and development of an independent validation screening tool: a systematic review. BMC Med 2024; 22:56. [PMID: 38317226 PMCID: PMC10845808 DOI: 10.1186/s12916-024-03273-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 01/23/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND A comprehensive overview of artificial intelligence (AI) for cardiovascular disease (CVD) prediction and a screening tool of AI models (AI-Ms) for independent external validation are lacking. This systematic review aims to identify, describe, and appraise AI-Ms of CVD prediction in the general and special populations and develop a new independent validation score (IVS) for AI-Ms replicability evaluation. METHODS PubMed, Web of Science, Embase, and IEEE library were searched up to July 2021. Data extraction and analysis were performed for the populations, distribution, predictors, algorithms, etc. The risk of bias was evaluated with the prediction risk of bias assessment tool (PROBAST). Subsequently, we designed IVS for model replicability evaluation with five steps in five items, including transparency of algorithms, performance of models, feasibility of reproduction, risk of reproduction, and clinical implication, respectively. The review is registered in PROSPERO (No. CRD42021271789). RESULTS In 20,887 screened references, 79 articles (82.5% in 2017-2021) were included, which contained 114 datasets (67 in Europe and North America, but 0 in Africa). We identified 486 AI-Ms, of which the majority were in development (n = 380), but none of them had undergone independent external validation. A total of 66 idiographic algorithms were found; however, 36.4% were used only once and only 39.4% over three times. A large number of different predictors (range 5-52,000, median 21) and large-span sample size (range 80-3,660,000, median 4466) were observed. All models were at high risk of bias according to PROBAST, primarily due to the incorrect use of statistical methods. IVS analysis confirmed only 10 models as "recommended"; however, 281 and 187 were "not recommended" and "warning," respectively. CONCLUSION AI has led the digital revolution in the field of CVD prediction, but is still in the early stage of development as the defects of research design, report, and evaluation systems. The IVS we developed may contribute to independent external validation and the development of this field.
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Affiliation(s)
- Yue Cai
- China Medical University, Shenyang, 110122, China
| | - Yu-Qing Cai
- China Medical University, Shenyang, 110122, China
| | - Li-Ying Tang
- China Medical University, Shenyang, 110122, China
| | - Yi-Han Wang
- China Medical University, Shenyang, 110122, China
| | - Mengchun Gong
- Digital Health China Co. Ltd, Beijing, 100089, China
| | - Tian-Ci Jing
- Smart Hospital Management Department, the First Hospital of China Medical University, Shenyang, 110001, China
| | - Hui-Jun Li
- Shenyang Medical & Film Science and Technology Co. Ltd., Shenyang, 110001, China
- Enduring Medicine Smart Innovation Research Institute, Shenyang, 110001, China
| | - Jesse Li-Ling
- Institute of Genetic Medicine, School of Life Science, State Key Laboratory of Biotherapy, Sichuan University, Chengdu, 610065, China
| | - Wei Hu
- Bayi Orthopedic Hospital, Chengdu, 610017, China
| | - Zhihua Yin
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, 110122, China.
| | - Da-Xin Gong
- Smart Hospital Management Department, the First Hospital of China Medical University, Shenyang, 110001, China.
- The Internet Hospital Branch of the Chinese Research Hospital Association, Beijing, 100006, China.
| | - Guang-Wei Zhang
- Smart Hospital Management Department, the First Hospital of China Medical University, Shenyang, 110001, China.
- The Internet Hospital Branch of the Chinese Research Hospital Association, Beijing, 100006, China.
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Jalepalli SK, Gupta P, Dekker ALAJ, Bermejo I, Kar S. Development and validation of multicentre study on novel Artificial Intelligence-based Cardiovascular Risk Score (AICVD). Fam Med Community Health 2024; 12:e002340. [PMID: 38238156 PMCID: PMC10806469 DOI: 10.1136/fmch-2023-002340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024] Open
Abstract
OBJECTIVE Cardiovascular diseases (CVD) are one of the most prevalent diseases in India amounting for nearly 30% of total deaths. A dearth of research on CVD risk scores in Indian population, limited performance of conventional risk scores and inability to reproduce the initial accuracies in randomised clinical trials has led to this study on large-scale patient data. The objective is to develop an Artificial Intelligence-based Risk Score (AICVD) to predict CVD event (eg, acute myocardial infarction/acute coronary syndrome) in the next 10 years and compare the model with the Framingham Heart Risk Score (FHRS) and QRisk3. METHODS Our study included 31 599 participants aged 18-91 years from 2009 to 2018 in six Apollo Hospitals in India. A multistep risk factors selection process using Spearman correlation coefficient and propensity score matching yielded 21 risk factors. A deep learning hazards model was built on risk factors to predict event occurrence (classification) and time to event (hazards model) using multilayered neural network. Further, the model was validated with independent retrospective cohorts of participants from India and the Netherlands and compared with FHRS and QRisk3. RESULTS The deep learning hazards model had a good performance (area under the curve (AUC) 0.853). Validation and comparative results showed AUCs between 0.84 and 0.92 with better positive likelihood ratio (AICVD -6.16 to FHRS -2.24 and QRisk3 -1.16) and accuracy (AICVD -80.15% to FHRS 59.71% and QRisk3 51.57%). In the Netherlands cohort, AICVD also outperformed the Framingham Heart Risk Model (AUC -0.737 vs 0.707). CONCLUSIONS This study concludes that the novel AI-based CVD Risk Score has a higher predictive performance for cardiac events than conventional risk scores in Indian population. TRIAL REGISTRATION NUMBER CTRI/2019/07/020471.
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Affiliation(s)
| | | | - Andre L A J Dekker
- Department of Radiation Oncology (Maastro), Maastricht University, Maastricht, Netherlands
| | - Inigo Bermejo
- Department of Radiation Oncology (Maastro), Maastricht University, Maastricht, Netherlands
| | - Sujoy Kar
- Apollo Hospitals, Hyderabad, Telangana, India
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Momayyezi M, Sefidkar R, Fallahzadeh H. Agreement between ten-years cardiovascular disease risk assessment tools: An application to Iranian population in Shahedieh Cohort Study. Heliyon 2023; 9:e20396. [PMID: 37810856 PMCID: PMC10556586 DOI: 10.1016/j.heliyon.2023.e20396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/10/2023] Open
Abstract
Background and aim Cardiovascular risk-prediction models are efficient primary prevention tools to detect high-risk individuals. The study aims to use three tools to estimate the 10-year risk of developing cardiovascular disease (CVD) and investigate their agreement in an Iranian adult population. Methods The current cross-sectional study was carried out on 8569 adults between 35 and 70 who participated in the first phase of the Shahedieh cohort study in Yazd, Iran, and were free of CVDs (cardiac ischemia or myocardial infarction or stroke). World Health Organization/International Society of Hypertension (WHO/ISH) chart, Laboratory-Based (LB) and Non-Laboratory-Based (NLB) Framingham Risk Score (FRS) were used to predict the 10-year risk of developing CVD. The agreement across tools was determined by Kappa. Results WHO/ISH chart indicated the highest prevalence of low CVD risk for males (96.10%) and females (96.50%), while NLB Framingham had the highest prevalence of high CVD risk for males (19.40%) and females (5.30%). In total, there was substantial agreement between both FRS models (Kappa = o.70), while there was a slight agreement between WHO/ISH and both FRS tools. For under 60 years males and females, substantial agreements were observed between FRS methods (kappa = 0.73 and kappa = 0.68). For males and females over 60 years, this agreement was moderate and substantial, respectively (kappa = 0.54 and kappa = 0.64). WHO/ISH and LB Framingham model had substantial agreement for over 60 years females (kappa = 0.61). Conclusions Framingham models classified more participants in the high-risk category than WHO/ISH. Due to the lethality of CVDs, categorizing individuals based on FRS can ensure that most of the real high-risk people are detected. Remarkable agreement between FRS methods in all sex-age groups suggested using the NLB Framingham model as a primary screening tool, especially in a shortage of resources condition.
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Affiliation(s)
- Mahdieh Momayyezi
- Center for Healthcare Data Modeling, Departments of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Reyhane Sefidkar
- Center for Healthcare Data Modeling, Departments of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Fallahzadeh
- Center for Healthcare Data Modeling, Departments of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Li JX, Li L, Zhong X, Fan SJ, Cen T, Wang J, He C, Zhang Z, Luo YN, Liu XX, Hu LX, Zhang YD, Qiu HL, Dong GH, Zou XG, Yang BY. Machine learning identifies prominent factors associated with cardiovascular disease: findings from two million adults in the Kashgar Prospective Cohort Study (KPCS). Glob Health Res Policy 2022; 7:48. [PMID: 36474302 PMCID: PMC9724436 DOI: 10.1186/s41256-022-00282-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Identifying factors associated with cardiovascular disease (CVD) is critical for its prevention, but this topic is scarcely investigated in Kashgar prefecture, Xinjiang, northwestern China. We thus explored the CVD epidemiology and identified prominent factors associated with CVD in this region. METHODS A total of 1,887,710 adults at baseline (in 2017) of the Kashgar Prospective Cohort Study were included in the analysis. Sixteen candidate factors, including seven demographic factors, 4 lifestyle factors, and 5 clinical factors, were collected from a questionnaire and health examination records. CVD was defined according to International Clinical Diagnosis (ICD-10) codes. We first used logistic regression models to investigate the association between each of the candidate factors and CVD. Then, we employed 3 machine learning methods-Random Forest, Random Ferns, and Extreme Gradient Boosting-to rank and identify prominent factors associated with CVD. Stratification analyses by sex, ethnicity, education level, economic status, and residential setting were also performed to test the consistency of the ranking. RESULTS The prevalence of CVD in Kashgar prefecture was 8.1%. All the 16 candidate factors were confirmed to be significantly associated with CVD (odds ratios ranged from 1.03 to 2.99, all p values < 0.05) in logistic regression models. Further machine learning-based analysis suggested that age, occupation, hypertension, exercise frequency, and dietary pattern were the five most prominent factors associated with CVD. The ranking of relative importance for prominent factors in stratification analyses showed that the factor importance generally followed the same pattern as that in the overall sample. CONCLUSIONS CVD is a major public health concern in Kashgar prefecture. Age, occupation, hypertension, exercise frequency, and dietary pattern might be the prominent factors associated with CVD in this region.In the future, these factors should be given priority in preventing CVD in future.
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Affiliation(s)
- Jia-Xin Li
- grid.12981.330000 0001 2360 039XGuangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, 74 Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080 China
| | - Li Li
- grid.12981.330000 0001 2360 039XDepartment of Respiratory and Critical Care Medicine, The First People’s Hospital of Kashi (The Affiliated Kashi Hospital of Sun Yat-Sen University), No.66, Yingbin Avenue, Kashgar City, 844000 China
| | - Xuemei Zhong
- grid.12981.330000 0001 2360 039XDepartment of Respiratory and Critical Care Medicine, The First People’s Hospital of Kashi (The Affiliated Kashi Hospital of Sun Yat-Sen University), No.66, Yingbin Avenue, Kashgar City, 844000 China
| | - Shu-Jun Fan
- grid.508371.80000 0004 1774 3337Guangzhou Center for Disease Control and Prevention, Guangzhou, 510440 China
| | - Tao Cen
- grid.284723.80000 0000 8877 7471Department of Research and Development, Nanfang Hospital, Southern Medical University, Guangzhou, 510515 China
| | - Jianquan Wang
- grid.12981.330000 0001 2360 039XDepartment of Respiratory and Critical Care Medicine, The First People’s Hospital of Kashi (The Affiliated Kashi Hospital of Sun Yat-Sen University), No.66, Yingbin Avenue, Kashgar City, 844000 China
| | - Chuanjiang He
- grid.12981.330000 0001 2360 039XDepartment of Respiratory and Critical Care Medicine, The First People’s Hospital of Kashi (The Affiliated Kashi Hospital of Sun Yat-Sen University), No.66, Yingbin Avenue, Kashgar City, 844000 China
| | - Zhoubin Zhang
- grid.508371.80000 0004 1774 3337Guangzhou Center for Disease Control and Prevention, Guangzhou, 510440 China
| | - Ya-Na Luo
- grid.12981.330000 0001 2360 039XGuangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, 74 Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080 China
| | - Xiao-Xuan Liu
- grid.12981.330000 0001 2360 039XGuangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, 74 Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080 China
| | - Li-Xin Hu
- grid.12981.330000 0001 2360 039XGuangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, 74 Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080 China
| | - Yi-Dan Zhang
- grid.12981.330000 0001 2360 039XGuangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, 74 Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080 China
| | - Hui-Ling Qiu
- grid.12981.330000 0001 2360 039XGuangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, 74 Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080 China
| | - Guang-Hui Dong
- grid.12981.330000 0001 2360 039XGuangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, 74 Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080 China
| | - Xiao-Guang Zou
- grid.12981.330000 0001 2360 039XDepartment of Respiratory and Critical Care Medicine, The First People’s Hospital of Kashi (The Affiliated Kashi Hospital of Sun Yat-Sen University), No.66, Yingbin Avenue, Kashgar City, 844000 China
| | - Bo-Yi Yang
- grid.12981.330000 0001 2360 039XGuangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, 74 Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080 China
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Recalibrating the Non-Communicable Diseases risk prediction tools for the rural population of Western India. BMC Public Health 2022; 22:376. [PMID: 35193546 PMCID: PMC8862298 DOI: 10.1186/s12889-022-12783-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 02/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of the present study was to recalibrate the effectiveness of Indian Diabetes Risk Score (IDRS) and Community-Based Assessment Checklist (CBAC) by opportunistic screening of Diabetes Mellitus (DM) and Hypertension (HT) among the people attending health centres, and estimating the risk of fatal and non-fatal Cardio-Vascular Diseases (CVDs) among them using WHO/ISH charts. METHODS All the people aged ≥ 30 years attending the health centers were screened for DM and HT. Weight, height, waist circumference, and hip circumferences were measured, and BMI and Waist-Hip Ratio (WHR) were calculated. Risk categorization of all participants was done using IDRS, CBAC, and WHO/ISH risk prediction charts. Individuals diagnosed with DM or HT were started on treatment. The data was recorded using Epicollect5 and was analyzed using SPSS v.23 and MedCalc v.19.8. ROC curves were plotted for DM and HT with the IDRS, CBAC score, and anthropometric parameters. Sensitivity (SN), specificity (SP), Positive Predictive Value (PPV), Negative Predictive Value (NPV), Accuracy and Youden's index were calculated for different cut-offs of IDRS and CBAC scores. RESULTS A total of 942 participants were included for the screening, out of them, 9.2% (95% CI: 7.45-11.31) were diagnosed with DM for the first time. Hypertension was detected among 25.7% (95% CI: 22.9-28.5) of the participants. A total of 447 (47.3%) participants were found with IDRS score ≥ 60, and 276 (29.3%) with CBAC score > 4. As much as 26.1% were at moderate to higher risk (≥ 10%) of developing CVDs. Area Under the Curve (AUC) for IDRS in predicting DM was 0.64 (0.58-0.70), with 67.1% SN and 55.2% SP (Youden's Index 0.22). While the AUC for CBAC was 0.59 (0.53-0.65). For hypertension both the AUCs were 0.66 (0.62-0.71) and 0.63 (0.59-0.67), respectively. CONCLUSIONS IDRS was found to have the maximum AUC and sensitivity thereby demonstrating its usefulness as compared to other tools for screening of both diabetes and hypertension. It thus has the potential to expose the hidden NCD iceberg. Hence, we propose IDRS as a useful tool in screening of Diabetes and Hypertension in rural India.
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Kavita, Unnas, Thakur J, Ghai S, Saini S. Task shifting of cardiovascular disease risk assessment to Anganwadi Worker in Northern India. J Family Med Prim Care 2022; 11:1109-1113. [PMID: 35495795 PMCID: PMC9051688 DOI: 10.4103/jfmpc.jfmpc_1119_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/09/2020] [Accepted: 10/14/2021] [Indexed: 11/04/2022] Open
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Thulani UB, Mettananda KCD, Warnakulasuriya DTD, Peiris TSG, Kasturiratne KTAA, Ranawaka UK, Chakrewarthy S, Dassanayake AS, Kurukulasooriya SAF, Niriella MA, de Silva ST, Pathmeswaran AP, Kato N, de Silva HJ, Wickremasinghe AR. Validation of the World Health Organization/ International Society of Hypertension (WHO/ISH) cardiovascular risk predictions in Sri Lankans based on findings from a prospective cohort study. PLoS One 2021; 16:e0252267. [PMID: 34097699 PMCID: PMC8183983 DOI: 10.1371/journal.pone.0252267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/13/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction and objectives There are no cardiovascular (CV) risk prediction models for Sri Lankans. Different risk prediction models not validated for Sri Lankans are being used to predict CV risk of Sri Lankans. We validated the WHO/ISH (SEAR-B) risk prediction charts prospectively in a population-based cohort of Sri Lankans. Method We selected 40–64 year-old participants from the Ragama Medical Officer of Health (MOH) area in 2007 by stratified random sampling and followed them up for 10 years. Ten-year risk predictions of a fatal/non-fatal cardiovascular event (CVE) in 2007 were calculated using WHO/ISH (SEAR-B) charts with and without cholesterol. The CVEs that occurred from 2007–2017 were ascertained. Risk predictions in 2007 were validated against observed CVEs in 2017. Results Of 2517 participants, the mean age was 53.7 year (SD: 6.7) and 1132 (45%) were males. Using WHO/ISH chart with cholesterol, the percentages of subjects with a 10-year CV risk <10%, 10–19%, 20%-29%, 30–39%, ≥40% were 80.7%, 9.9%, 3.8%, 2.5% and 3.1%, respectively. 142 non-fatal and 73 fatal CVEs were observed during follow-up. Among the cohort, 9.4% were predicted of having a CV risk ≥20% and 8.6% CVEs were observed in the risk category. CVEs were within the predictions of WHO/ISH charts with and without cholesterol in both high (≥20%) and low(<20%) risk males, but only in low(<20%) risk females. The predictions of WHO/ISH charts, with-and without-cholesterol were in agreement in 81% of subjects (ĸ = 0.429; p<0.001). Conclusions WHO/ISH (SEAR B) risk prediction charts with-and without-cholesterol may be used in Sri Lanka. Risk charts are more predictive in males than in females and for lower-risk categories. The predictions when stratifying into 2 categories, low risk (<20%) and high risk (≥20%), are more appropriate in clinical practice.
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Affiliation(s)
- U. B. Thulani
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - K. C. D. Mettananda
- Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
- * E-mail:
| | | | - T. S. G. Peiris
- Department of Mathematics, Faculty of Engineering, University of Moratuwa, Moratuwa, Sri Lanka
| | | | - U. K. Ranawaka
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - S. Chakrewarthy
- Department of Biochemistry, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - A. S. Dassanayake
- Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | | | - M. A. Niriella
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - S. T. de Silva
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - A. P. Pathmeswaran
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - N. Kato
- National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo, Japan
| | - H. J. de Silva
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - A. R. Wickremasinghe
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
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Ettiappan S, Ponnusamy M. Cardiovascular Risk Scores in Women Undergoing Stress Myocardial Perfusion Scan and Comparison with Scan-Predicted Risk. Indian J Nucl Med 2020; 35:305-309. [PMID: 33642754 PMCID: PMC7905267 DOI: 10.4103/ijnm.ijnm_50_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/09/2020] [Accepted: 05/18/2020] [Indexed: 11/10/2022] Open
Abstract
Background: Death due to cardiovascular disease is a major concern in the field of noncommunicable disease. Assessment of cardiovascular risk score using Framingham score and WHO/ISH score is a noninvasive, easier method of predicting the adverse cardiovascular event in the general population. Aims and Objectives: The aim of the study was to assess the cardiovascular risk using Framingham score and WHO/ISH in women undergoing stress myocardial perfusion imaging (MPI) and comparison with scan-predicted risk. Materials and Methods: Adult females with suspected coronary artery disease referred to the department of nuclear medicine for 2 months were included in the study. Data pertaining to the risk score assessment were collected, and the risk scores were calculated. Subsequently, the patients underwent scheduled Tc-99m methoxy-isobutyl-isonitrile myocardial stress imaging, and scan-predicted risks were calculated. Then, the risk score of Framingham and WHO/ISH methods were compared with stress myocardial perfusion score using Cohen's kappa statistic. Results: The mean age of the sample was 52 years (standard deviation: 11). Framingham and WHO/ISH risk scores predicted low, intermediate, and high risk in 62.2%, 28.9%, and 8.9% and 68.9%, 22.1%, and 8.89% of the population. The two scoring methods showed moderate agreement (κ =0.59). However, the scores showed only slight and fair agreement, respectively, with risk predicted by stress MPI. Conclusion: Although the risk scores have been shown to benefit in screening general population, they may not perform well in symptomatic patients with suspected angina. Out of the two methods, WHO/ISH fares better than Framingham score in this population.
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Affiliation(s)
- Sukumar Ettiappan
- Department of Nuclear Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Madhusudhanan Ponnusamy
- Department of Nuclear Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Pramanik B, Ghosh A. Development of an Efficient, Non-Invasive Method for Cardiovascular Disease Risk Stratification in a Resource-Limited Setting. Curr Aging Sci 2020; 12:91-99. [PMID: 31769361 DOI: 10.2174/1874609812666190618105111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/15/2019] [Accepted: 05/19/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Augmentation Index (AIx) is considered as an important predictor of cardiovascular disease. So, quantification of AIx may provide a rapid cost-effective and non-invasive means of cardiovascular risk stratification. At present, WHO/ISH risk prediction charts are used to predict 10-year risk of a fatal or nonfatal major cardiovascular event, an assessment which requires laboratory support for blood chemistry and thus making it ill-suited for resource-limited settings. OBJECTIVES In this study, we examined the association of AIx with cardiovascular risk as determined by the WHO/ISH chart and identified AIx cut-offs to stratify patients into different risk categories. METHODS A case-control study with 162 cases and 61 controls was conducted in a tertiary care hospital in eastern India. Data were obtained for demographic, anthropometric, cardiovascular, and biochemical parameters. Cardiovascular risk assessment was carried out by WHO/ISH risk model in R. Statistical analysis was done for examining the association of AIx with WHO/ISH cardiovascular risk and for identifying AIx cut-offs to stratify patients into different risk categories. RESULTS Box and whisker plots for assessing the correlation between AIx and WHO/ISH cardiovascular risk showed an increase in the median value of AIx with increasing risk in both cases and controls. Heart rate corrected AIx showed a steady increase with increasing risk in males. AIx cutoffs showed good sensitivity and specificity for each risk category. CONCLUSION AIx is remarkably associated with cardiovascular risk as assessed by the WHO/ISH chart and the AIx cut-offs obtained in the study can be used as an efficient, non-invasive surrogate biomarker of cardiovascular risk even in resource-limited settings.
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Affiliation(s)
- Biswarup Pramanik
- Department of Physiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Amit Ghosh
- Department of Physiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Aw M, Ochieng BO, Attambo D, Opot D, Aw J, Francis S, Hawkes MT. Critical appraisal of a mHealth-assisted community-based cardiovascular disease risk screening program in rural Kenya: an operational research study. Pathog Glob Health 2020; 114:379-387. [PMID: 32896232 DOI: 10.1080/20477724.2020.1816286] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Community health workers (CHWs) can participate in the cascade of hypertension and diabetes management in low and middle-income countries (LMICs). Their services may be enhanced with mobile health (mHealth) tools. In this operational research study, we describe the AFYACHAT mHealth-assisted cardiovascular health screening program in rural Kenya. In this study, A CHW screened a convenience sample of adults ≥ 40 years old in rural Kenya for cardiovascular disease (CVD) risk using the two-way AFYACHAT mHealth instrument. AFYACHAT analyzes a patient's age, sex, smoking, diabetes and systolic blood pressure and provides a four-tiered 10-year CVD risk score. User acceptability was assessed by an end-of-study interview with the CWH. Automated error logs were analyzed. Patient satisfaction was measured with a six-question satisfaction questionnaire. Screened participants with high CVD risk were followed-up via telephone to explore any actions taken following screening. In 24 months, one CHW screened 1650 participants using AFYACHAT. The 10-year risk of CVD was <10% for 1611 (98%) patients, 10 to <20% for 26 (1.6%), 20 to <30% in 12 (0.7%), and ≥30% for 1 (0.1%). The point prevalence of hypertension and diabetes was 27% and 1.9%, respectively. Seventy-five percent of participants with elevated CVD risk sought further medical care. There was high acceptability, a 15% miscode error rate, and high participant satisfaction with the screening program. Our operational research outlines how AFYACHAT mHealth tool can assist CHW perform rapid CVD screening; this provides a model framework for non-communicable disease screening in LMICs.
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Affiliation(s)
- Michael Aw
- Department of Medicine, McMaster University , Hamilton, Ontario, Canada
| | - Benard Omondi Ochieng
- Department of community engagement, Kenya Medical Research Institute , Kisumu, Kenya
| | - Daniel Attambo
- Department of community engagement, Lewa Wildlife Conservancy , Isiolo District, Kenya
| | - Danet Opot
- Department of community engagement, Kenya Medical Research Institute , Kisumu, Kenya
| | - James Aw
- Department of corporate social responsibility (Naweza), Medcan Corporation , Toronto, Canada
| | - Stacy Francis
- Department of corporate social responsibility (Naweza), Medcan Corporation , Toronto, Canada
| | - Michael T Hawkes
- Department of corporate social responsibility (Naweza), Medcan Corporation , Toronto, Canada.,Department of Pediatrics, University of Alberta , Edmonton, Canada.,School of Public Health, University of Alberta , Edmonton, Canada.,Distinguished Researcher, Stollery Science Lab, University of Alberta , Edmonton, Canada.,Member, Women and Children's Research Institute, University of Alberta , Edmonton, Canada
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11
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Ponraj DGS, Gopikrishnan SK, Newtonraj A, Arokiaraj MC, Purty AJ, Nanda SK, Manikandan M, Vincent A. Cardiovascular risk using WHO-ISH chart among Diabetes and Hypertensive patients in a remote rural area of South India. J Family Med Prim Care 2020; 9:4145-4150. [PMID: 33110823 PMCID: PMC7586597 DOI: 10.4103/jfmpc.jfmpc_538_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 04/26/2020] [Accepted: 05/11/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Cardiovascular diseases (CVDs) are major problems in India and many other developing and developed countries. As India is committed to provide universal health care for the population, there is a need to find out the prevalence and determinants of CVD risk among high-risk individuals (Diabetes and Hypertensive patients) in the remote rural area of India to deliver appropriate services, as they are considered as neglected population. METHODS We screened high-risk individuals (Hypertension and Diabetes patients) for CVD risk using WHO/ISH chart, in a remote rural area of south India, covering ten villages surrounding the Rural Health Training Centre (RHTC), in August-September 2017. After line-listing the participants from the electronic database of RHTC, screening with questionnaire and biochemical tests was done at village level as the first step. Thereafter, the participants were invited to the hospital on a particular day where electrocardiography (ECG) and echocardiography (ECHO) were done with special consultation. RESULTS Among the total of 303 individuals screened at the village level, 64 [21%(CI 17-25)] had a higher risk for CVD. 235 people attended the special consultation; among them, 212 underwent ECG and 88 underwent ECHO. Among those screened with ECHO, 18 had some cardiac pathologies. The relationship between CVD risk and other factors is shown in. After final adjustment, illiteracy [adjusted prevalence ratio (aPR) 1.8 (0.1-3.1)], anemia [aPR 1.8 (1-3.6)], and chronic renal diseases [aPR 1.8 (1.0-3.4)] were found to be associated with high risk for CVD among hypertension and diabetes groups. CONCLUSION Cardiovascular disease risk assessment using WHO/ISH chart showed an association with poor education, anemia, and chronic kidney disease.
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Affiliation(s)
| | | | - Ariarathinam Newtonraj
- Department of Community Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
| | | | - Anil Jacob Purty
- Department of Community Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Sunil Kumar Nanda
- Department of Biochemistry, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Mani Manikandan
- Department of Community Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Antony Vincent
- Department of Community Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
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12
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Zhu H, Xi Y, Bao H, Xu X, Niu L, Tao Y, Cao N, Wang W, Zhang X. Assessment of cardiovascular disease risk in Northern China: a cross-sectional study. Ann Hum Biol 2020; 47:498-503. [PMID: 32618477 DOI: 10.1080/03014460.2020.1779814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Cardiovascular disease (CVD) is a life-threatening chronic illness. CVD risk may be influenced by environment and lifestyle. People in northern China usually consume high-fat, high-salt diets and alcohol and live in a cold climate over long periods. However, there are limited studies on CVD risk among people in northern China. In the present study, we sought to estimate the CVD risk profile among residents of northern China. Using the Programme of Screening and Intervention Subjects with High Risk Cardiovascular Diseases, we collected data from residents in six cities from September 2015 to June 2017. In total, 56,716 participants aged 40 years and above were finally included in the CVD risk assessment. To assess the 10-year risk of CVD among participants, we used World Health Organisation/International Society of Hypertension risk prediction charts. Among the study participants, 22.7% had a high 10-year risk of CVD. We identified differences in the 10-year CVD risk according to sex, socioeconomic status, and marital status. We conclude that individuals with high socioeconomic status should be encouraged to change their lifestyle habits, and greater medical resources should be invested for individuals residing in rural areas and those with low education levels.
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Affiliation(s)
- Hao Zhu
- Public Health College, Inner Mongolia Medical University, Hohhot, China
| | - Yunfeng Xi
- The Inner Mongolia Autonomous Region Comprehensive Center of Disease Control and Prevention, Hohhot, China
| | - Han Bao
- Public Health College, Inner Mongolia Medical University, Hohhot, China
| | - Xiaoqian Xu
- Public Health College, Inner Mongolia Medical University, Hohhot, China
| | - Liwei Niu
- Public Health College, Inner Mongolia Medical University, Hohhot, China
| | - Yan Tao
- Public Health College, Inner Mongolia Medical University, Hohhot, China
| | - Ning Cao
- Public Health College, Inner Mongolia Medical University, Hohhot, China
| | - Wenrui Wang
- The Inner Mongolia Autonomous Region Comprehensive Center of Disease Control and Prevention, Hohhot, China
| | - Xingguang Zhang
- Public Health College, Inner Mongolia Medical University, Hohhot, China
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Rosu MM, Popa SG, Mota E, Popa A, Manolache M, Guja C, Bala C, Mota C, Mota M. CARDIOVASCULAR RISK ASSESSMENT IN THE ADULT (AGED 40-79 YEARS) ROMANIAN POPULATION. ACTA ENDOCRINOLOGICA-BUCHAREST 2018; 14:227-234. [PMID: 31149262 DOI: 10.4183/aeb.2018.227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Atherosclerotic Cardiovascular Diseases are the leading cause of death worldwide. Aim To estimate the prevalence of cardiovascular risk (CVR) categories in the adult population (aged 40-79 years) of Romania. Design The present study was part of the epidemiological, cross-sectional PREDATORR study (PREvalence of DiAbeTes mellitus, prediabetes, overweight, Obesity, dyslipidemia, hyperuricemia and chronic kidney disease in Romania). Subjects and Methods Exclusion criteria: age <40/or>79 years old and diagnosis of ischemic vascular disease. The CVR was evaluated using charts developed by the World Health Organization/ International Society of Hypertension (WHO/ISH) available for Europe B (epidemiological sub-region where Romania was included). The CVR was divided into 5 categories: <10%, 10-20%, 20-30%, 30-40%, > 40%. Results A total of 1631 subjects (57.0±10.7 years, 45.1% males) were included in the present study.The age and sex-adjusted prevalence of CVR >40% was 2.9% (95%CI 2.8-3.1%), CVR 30-40% was 1.85% (95%CI 1.8-1.9%), CVR 20-30% was 5.8% (95%CI 5.6-6.0%) and 13.0% (95%CI 12.8-13.3%) of the adult Romanian population has a 10-20% CVR, these CVR categories being more frequent in male and older age. Diabetes, overweight/obesity and smoking were associated with high CVR categories. Conclusion Romania is one of the countries with high CVR, requiring CVD prevention measures.
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Affiliation(s)
- M M Rosu
- Clinical County Emergency Hospital Craiova, Romania, Dept. of Diabetes, Nutrition and Metabolic Diseases, Craiova University of Medicine and Pharmcy, Romania
| | - S G Popa
- Dept. of Diabetes, Nutrition and Metabolic Diseases, Romania
| | - E Mota
- Dept. of Nephrology, Romania
| | - A Popa
- Clinical Emergency Hospital, Department of Diabetes, Nutrition and Metabolic Diseases - Craiova, Romania
| | | | - C Guja
- "N.C. Paulescu" National Institute of Diabetes, Nutrition and Metabolic Diseases - Bucharest, Romania
| | - C Bala
- "Iuliu Hatieganu" University of Medicine and Pharmacy - Diabetes, Nutrition and Metabolic Diseases - Cluj-Napoca, Romania
| | - C Mota
- "Iuliu Hatieganu" University of Medicine and Pharmacy - Diabetes, Nutrition and Metabolic Diseases - Cluj-Napoca, Romania
| | - M Mota
- Dept. of Diabetology, Romania.,Clinical Emergency Hospital, Department of Diabetes, Nutrition and Metabolic Diseases - Craiova, Romania
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14
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Collins D, Lee J, Bobrovitz N, Koshiaris C, Ward A, Heneghan C. whoishRisk - an R package to calculate WHO/ISH cardiovascular risk scores for all epidemiological subregions of the world. F1000Res 2016; 5:2522. [PMID: 28357040 PMCID: PMC5345772 DOI: 10.12688/f1000research.9742.2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/06/2017] [Indexed: 02/03/2023] Open
Abstract
The World Health Organisation and International Society of Hypertension (WHO/ISH) cardiovascular disease (CVD) risk assessment charts have been implemented in many low- and middle-income countries as part of the WHO Package of Essential Non-Communicable Disease (PEN) Interventions for Primary Health Care in Low-Resource settings. Evaluation of the WHO/ISH cardiovascular risk charts and their use is a key priority and since they only existed in paper or PDF formats, we developed an R implementation of the charts for all epidemiological subregions of the world. The main strengths of this implementation are that it is built in a free, open-source, coding language with simple syntax, can be downloaded from github as a package (“whoishRisk”), and can be used with a standard computer.
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Affiliation(s)
- Dylan Collins
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Joseph Lee
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Niklas Bobrovitz
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Alison Ward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Carl Heneghan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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