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Predicting coronary heart disease using risk assessment charts and risk factor categories

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Abstract

Background

Cardiovascular disease is the leading cause of death and disability in Egypt. An appropriate estimation of risk is important to improve cardiovascular outcomes and ensure efficient allocation of resources used to support disease prevention. Risk prediction charts have been developed to provide clinicians with a simple tool to estimate the absolute risk of developing coronary heart disease (CHD).

Objectives

To test the accuracy of the World Health Organization/International Society of Hypertension (WHO/ISH) risk prediction charts in predicting and identifying people at risk of developing CHD and to propose an alternative risk assessment instrument based on simple laboratory tests, routine examination, and reported personal and medical data.

Methods

A cross-sectional screening survey was conducted at an emergency department of a health insurance hospital in Alexandria, Egypt. A total of 350 enrolled patients were evaluated clinically. We applied the WHO/ISH risk assessment chart for the Eastern Mediterranean region to test its accuracy in predicting CHD.

Results

The validation statistics indicated that the WHO/ISH risk prediction charts identified cases with CHD with 60.0% sensitivity and 93.2% specificity. At least nine risk factors for developing CHD were detected in all patients in the study cohort. Hypertension was the strongest predictor of CHD [odds ratio (OR) (95% confidence interval (CI)): 20.8 (5.6–76.9)]. Silent cardiovascular risk factors were ascertained in about 30% of the studied population, a finding that did not differ significantly by sex. We propose a different risk assessment model for general practice that incorporates standard cardiovascular risk factors, with or without laboratory tests.

Conclusions

Standard cardiovascular risk factors included in a simple risk prediction algorithm can predict multivariate CHD risk in apparently healthy individuals. Non-laboratory-based risk assessment models have no superior advantage over those employing laboratory investigations.

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Abbreviations

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

ATP III:

Adult Treatment Panel III

BMI:

Body mass index

CDC:

Centers for Disease Control and Prevention

CHD:

Coronary heart disease

CK-MB:

Creatine kinase-muscle/brain

COPD:

Chronic obstructive pulmonary disease

CPK:

Creatine phosphokinase

CRP:

C-reactive protein

CVD:

Cardiovascular disease

DBP:

Diastolic blood pressure

DM:

Diabetes mellitus

ECG:

Electrocardiography

EMR D:

Eastern Mediterranean region (D version)

FBS:

Fasting blood sugar

HbA1c:

Glycosylated hemoglobin concentration

HDL:

High-density lipoprotein

hsCRP:

High-sensitivity C-reactive protein

IHD:

Ischemic heart disease

LDH:

Lactate dehydrogenase

LDL:

Low-density lipoprotein

NCD:

Non-communicable disease

NCEP:

National Cholesterol Education Program

PVD:

Peripheral vascular disease

ROC:

Receiver operating characteristic

SBP:

Systolic blood pressure

TC:

Total cholesterol

WHO/ISH:

World Health Organization/International Society of Hypertension

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Author information

Correspondence to Ekram W. Abd El-Wahab.

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Conflict of interest

The author declares that she has no conflict of interest.

Ethical approval

The study was approved by the Institutional Review Board and the Ethics Committee of the High Institute of Public Health affiliated to Alexandria University, Egypt. The research was conducted in accordance with the ethical guidelines of the 1964 Helsinki declaration and its later amendments and the International Conference on Harmonization Guidelines for Good Clinical Practice.

Informed consent

All patients were invited to voluntarily sign an informed written consent after explaining the aim and concerns of the study. Data sheets were coded to ensure the anonymity and confidentiality of patients’ data.

ARRIVE guidelines/institutional animal care and use committee statement

The current research did not involve animal work.

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Abd El-Wahab, E.W. Predicting coronary heart disease using risk assessment charts and risk factor categories. J Public Health (Berl.) (2020). https://doi.org/10.1007/s10389-020-01224-z

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Keywords

  • Coronary heart disease
  • Prediction
  • Risk assessment chart