Application of two versions of the WHO/international society of hypertension absolute cardiovascular risk assessment tools in a rural Bangladeshi population

Authors

Kaniz Fatema, University of New South Wales, Bangladesh University of Health Sciences
Nicholas Arnold Zwar, University of New South WalesFollow
Abdul Hasnat Milton, University of Newcastle
Bayzidur Rahman, University of New South Wales
Liaquat Ali, Bangladesh University of Health Sciences

RIS ID

111777

Publication Details

Fatema, K., Zwar, N. Arnold., Milton, A. Hasnat., Rahman, B. & Ali, L. (2015). 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), 008140-1-008140-7.

Abstract

Objectives: To estimate the absolute cardiovascular disease (CVD) risk burden in a remote rural Bangladeshi population using the 'With' and 'Without' Cholesterol versions of the WHO/International Society of Hypertension (WHO/ISH) CVD risk assessment chart (particularly suitable for low and middle-income countries due to less reliance on laboratory testing) and to evaluate the agreement between the two approaches. Design: Cross-sectional study using data from a large prospective cohort of the North Bengal Non-Communicable Disease Programme (NB-NCDP) of Bangladesh. Setting: General rural population from Thakurgaon district of Bangladesh. Participants: 563 individuals who were categorised as having 'no CVDs' on screening by a questionnairebased survey using the 'WHO CVD-Risk Management Package' developed in 2002. Main outcome measures: Absolute CVD risk burden assessed using two versions of the WHO/ISH risk assessment charts for the South-East Asian Region-D. Results: 10-year risk (moderate, high and very high) positivity was present among 21.5% and 20.2% of participants, respectively, using with and without cholesterol versions of the tool. The overall concordance rate for the two versions was 89.5% and they did not differ significantly in estimating the proportion of overall participants having higher levels of CVD. The projected drug requirement, however, showed a significant overestimation in the proportion of participants at both the threshold levels (p0.002) on using 'without' as compared to 'with' cholesterol versions. Conclusions: About one-fifth of the adult population in Bangladesh, even in a remote rural area, seem to be at risk of developing CVDs (25% of them at high risk and 25% at very high risk) within 10 years with males and females being almost equally vulnerable.