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

• Published in: PloS one Vol. 16; no. 6; p. e0252267
• Main Authors: Thulani, U. B, Mettananda, K. C. D, Warnakulasuriya, D. T. D, Peiris, T. S. G, Kasturiratne, K. T. A. A, Ranawaka, U. K, Chakrewarthy, S, Dassanayake, A. S, Kurukulasooriya, S. A. F, Niriella, M. A, de Silva, S. T, Pathmeswaran, A. P, Kato, N, de Silva, H. J, Wickremasinghe, A. R
• Format: Journal Article
• Language: English
• Published: San Francisco Public Library of Science 07-06-2021; Public Library of Science (PLoS)
• Subjects: Asian people; Biochemistry; Biology and Life Sciences; Blood pressure; Cardiovascular disease; Cardiovascular diseases; Cerebral infarction; Charts; Cholesterol; Cohort analysis; Computer and Information Sciences; Diabetes; Diabetes mellitus; Editing; Epidemiology; Funding; Health risks; Heart diseases; Hypertension; Mathematical models; Medicine; Medicine and Health Sciences; Methodology; Myocardial infarction; People and places; Pharmacology; Physical Sciences; Prediction models; Public health; Research and Analysis Methods; Risk; Risk factors; Visualization; Sri Lanka; Japan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0252267

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.