title: Comparability of total cardiovascular disease risk estimates using laboratory and non-laboratory based assessments in urban-dwelling South Africans: the CRIBSA study.
abstract: OBJECTIVE
  To establish the prevalence and determinants of the 10-year risk of a cardiovascular disease (CVD) event in 25 - 74-year-old black Africans in Cape Town, South Africa, using Framingham laboratory- and non-laboratory-based and National Health and Nutrition Examination Survey (NHANES) I non-laboratory-based equations.
  
  
  METHODS
  CVD risk factors were determined by questionnaires, clinical measurements and biochemical analyses. Survey logistic regression analyses assessed the sociodemographic determinants of CVD risk ≥20%.
  
  
  RESULTS
  There were 1 025 participants, 369 men and 656 women. Mean 10-year risk for a CVD event by Framingham laboratory- and non-laboratory-based and NHANES I non-laboratory-based equations for men was 9.0% (95% confidence interval 7.7 - 10.3), 11.1% (9.6 - 12.6) and 9.0% (7.6 - 10.3), and for women 5.4% (4.7 - 6.1), 6.8% (5.9 - 7.7) and 8.7% (7.6 - 9.8). Correlations between laboratory- and non-laboratory-based scores were high (0.915 - 0.963). The prevalence of laboratory-based CVD risk ≥20% was 13.0% in men and 6.1% in women. In the logistic model for men, ≤7 years of education (odds ratio 3.09; 95% CI 1.67 - 5.71) and being unemployed (3.44; 1.21 - 9.81) compared with employed were associated with laboratory-based high risk. In women, high risk was associated with ≤7 years of education (4.20; 1.96 - 9.01), living in formal v. informal housing (2.74; 1.24 - 6.06) and being poor (middle v. lowest tertile 0.29; 0.13 - 0.66). In the Framingham non-laboratory-based logistic models there were no changes in the direction or significance of the variables except for housing, which was no longer significant in women.
  
  
  CONCLUSIONS
  Comparability of laboratory- and non-laboratory-based CVD risk estimates illustrates the utility of the latter in resource-constrained settings.
authors.affiliation: Non-communicable Diseases Research Unit, Medical Research Council, Durban, South Africa. nasheeta.peer@mrc.ac.za.
authors.forename: Nasheeta
authors.initials: N
authors.lastname: Peer
authors.forename: Carl
authors.initials: C
authors.lastname: Lombard
authors.forename: Krisela
authors.initials: K
authors.lastname: Steyn
authors.forename: Thomas
authors.initials: T
authors.lastname: Gaziano
authors.forename: Naomi
authors.initials: N
authors.lastname: Levitt
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control; D019411:Clinical Laboratory Techniques / Q000706:statistics & numerical data; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D050171:Dyslipidemias / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D016017:Odds Ratio; D050177:Overweight / Q000175:diagnosis / Q000453:epidemiology; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D013019:South Africa / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014505:Urban Population