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Indian J Public Health. 2019 Apr-Jun;63(2):101-106. doi: 10.4103/ijph.IJPH_178_18.

Concordance between two versions of world health organization/international society of hypertension risk prediction chart and framingham risk score among postmenopausal women in a rural area of Bangladesh.

Author information

1
Lecturer, Department of Noncommunicable Diseases, Bangladesh University of Health Sciences, Dhaka, Bangladesh.
2
Assistant Professor and Head, Department of Noncommunicable Diseases, Bangladesh University of Health Sciences, Dhaka, Bangladesh.
3
Assistant Professor, Department of Noncommunicable Diseases, Bangladesh University of Health Sciences, Dhaka, Bangladesh.
4
Honorary Professor, Department of Biochemistry and Cell Biology, Bangladesh University of Health Sciences, Dhaka, Bangladesh.

Abstract

Background:

Prevention of cardiovascular disease (CVD) among postmenopausal women with limited resource is a great challenge for a country like Bangladesh.

Objectives:

This study aimed to evaluate the level of agreement among different risk prediction tools to find out the cost-effective and suitable one that can be applied in a low-resource setting.

Methods:

This was a cross-sectional study conducted from February through December 2016 among 265 postmenopausal women of 40-70 years age. Data were collected from the outpatient department of a rural health-care center situated in the village Karamtola of Gazipur district, Bangladesh. The CVD risk was estimated using the World Health Organization/International Society of Hypertension (WHO/ISH) "with" and "without" cholesterol risk charts and the Framingham Risk Score (FRS). Concordance among the tools was evaluated using Cohen's kappa (κ), prevalence-adjusted bias-adjusted kappa (PABAK), and first-order agreement coefficient (AC1).

Results:

The "without" cholesterol version showed 79% concordance against the "with" cholesterol and 75.4% concordance against the FRS. In between the WHO/ISH risk charts, slight-to-substantial levels of agreement (κ = 0.14, PABAK = 0.58, and AC1 = 0.72; P = 0.023) were observed. With FRS, the "without" cholesterol version showed higher agreement (κ = 0.38, fair; PABAK = 0.50, moderate; and AC1 = 0.60, moderate; P = 0.000) compared to "with" cholesterol version (κ = 0.13, slight; PABAK = 0.30, fair; and AC1 = 0.44, moderate; P = 0.013). Predictability of CVD risk positive (≥10%) cases was similar for both the versions of WHO/ISH risk charts.

Conclusion:

In a low-resource setting, the "without" cholesterol version of WHO/ISH risk chart is a good option to detect and target the population with high CVD risk.

KEYWORDS:

Bangladesh; Framingham Risk Score; World Health Organization/International Society of Hypertension risk charts; cardiovascular risk assessment; concordance; postmenopausal women

PMID:
31219057
DOI:
10.4103/ijph.IJPH_178_18
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