Scimex: For the first time, scientists have developed a new scoring system that
can predict the 10-year risk of developing heart disease or having a
stroke, in people aged 40 years or older. The risk score, called
Globorisk, was developed using data from eight previous studies
involving over 50,000 people, and unlike previous scores, can be adapted
for use in any country.
For the first time, scientists have developed a new risk score that can predict
the 10-year risk of developing heart disease or having a stroke in persons aged
40 years or older in any world country.
The research is published in The
Lancet Diabetes & Endocrinology journal, and was led by Dr
Goodarz Danaei, Assistant Professor of Global Health at the Harvard T. H. Chan
School of Public Health in Boston, USA.
Danaei and colleagues developed, validated, and evaluated the new score,
called Globorisk, using data from eight cohort studies, including more than
50 000 participants. Unlike previous risk scores, Globorisk can be updated to
fit local conditions and risk factor levels in different countries using
routinely available information.
Dr Danaei explains, "Globorisk is an important advance in the field of
global cardiovascular disease prevention. Until now, most prediction scores
were developed using a single cohort study and were never validated for
accuracy in national populations for low- and middle-income countries.
Therefore, clinicians and public health policy makers in these countries were
left without a reliable tool to predict cardiovascular risk in their patients,
community, or country."
Globorisk measures cardiovascular risk in individuals aged 40 or older
by factoring in the person's smoking status, blood pressure, diabetes status,
and total cholesterol level, whilst adjusting for the effects of sex and age on
cardiovascular disease between countries.
The researchers recalibrated and applied their risk score to 11 countries from
different world regions [3], using data from recent national health surveys to
replace the average age-and-sex risk factor levels in each country and
incorporating cardiovascular disease death rates for each age-and-sex group.
They developed country-specific risk charts for predicting individuals' risk of
cardiovascular disease (see figure 4 pages 7-14), and country-specific
assessments of the 10-year cardiovascular disease burden (see figure 5 page
15).
They estimate that the proportion of people at high risk (10% or higher)
of having a fatal heart attack or stroke within 10 years is higher in low- and
middle-income countries (eg, China and Mexico) compared with high-income
countries (eg, South Korea, Spain, and Denmark). For example, in China around a
third of men and women (nearly 170 million aged between 40 and 84 years) have a
high 10-year risk of dying from a cardiovascular event compared with only 5–10%
of men and women in Spain and Denmark (see figure 5 page 15).
According to Dr Danaei, "Globorisk can be used to identify individuals
at high risk of developing cardiovascular disease who are most likely to
benefit from lifestyle changes or preventive drug treatment. Moreover, by
estimating the number of people who have a high risk in any given country we
have more chance of accurately measuring progress towards the WHO target of 50%
coverage of multidrug treatment and counselling for people aged 40 years and
older at high risk of cardiovascular disease."
Karel Moons from the
Utrecht University Medical Center in the Netherlands and Ewoud Schuit from the
same centre and from Stanford University in the USA, both authors of a linked
Comment, say, "A next step would be to quantify the effects, on a population
level, of introducing in these countries the Globorisk model combined with
subsequent risk-based preventative management. These quantifications
might further help, and indeed convince, decision-makers across the world to
decide on wide-scale introduction of prediction models and risk-based
management for cardiovascular disease."