title: Relationship between different cardiovascular risk scores and measures of subclinical atherosclerosis in an Indian population.
abstract: BACKGROUND
  Relative accuracy of the various currently available cardiovascular (CV) risk assessment algorithms in Indian patients is not known.
  
  
  METHODS
  This study included 194 consecutive patients (mean age 49.6 ± 10.3 years, 84.5% males) attending a CV disease prevention clinic at a tertiary center in north India. Four risk assessment models [Framingham Risk score (RiskFRS), American College of Cardiology/American Heart Association pooled cohort equations (RiskACC/AHA), the 3rd iteration of Joint British Societies' risk calculator (RiskJBS) and the World Health Organization/International Society of Hypertension risk prediction charts (RiskWHO)] were applied. The estimated risk scores were correlated with carotid intima-media thickness (CIMT) and coronary calcium score (CCS) using nonparametric statistics (Chi-square test, Kruskal-Wallis test and Spearman rank correlation).
  
  
  RESULTS
  Overall, RiskACC/AHA and RiskWHO significantly underestimated CV risk as compared to RiskJBS and RiskFRS, with RiskJBS being the least likely to underestimate the risk (patients with coronary artery disease who were found to have ≥20% CV risk- 21.4% with RiskACC/AHA, 17.9% with RiskWHO, 41.4% with RiskFRS, and 58.6% with RiskJBS). Further, only RiskJBS and RiskFRS, but not RiskACC/AHA and RiskWHO, demonstrated consistent relationship with CIMT and CCS (Spearman rho 0.45 and 0.46 for RiskJBS and 0.39 and 0.36 for RiskFRS for CIMT and CCS respectively, all p values < 0.001).
  
  
  CONCLUSIONS
  The present study shows that in Indian subjects RiskJBS appears to provide the most accurate estimation of CV risk. It least underestimates the risk and has the best correlation with CIMT and CCS. However, large-scale prospective studies are needed to confirm these findings.
authors: Senior Consultant, Cardiology, Medanta - The Medicity, Gurgaon, India. Electronic address: manishaiims@hotmail.com.
authors: Manish
authors: M
authors: Bansal
authors: Chairman, Clinical and Preventive Cardiology, Medanta - The Medicity, Gurgaon, India.
authors: Ravi R
authors: RR
authors: Kasliwal
authors: Chairman, Cardiothoracic Surgery, Medanta - The Medicity, Gurgaon, India.
authors: Naresh
authors: N
authors: Trehan
mesh_terms: D000328:Adult; D050197:Atherosclerosis / Q000175:diagnosis / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology; D059168:Carotid Intima-Media Thickness; D017023:Coronary Angiography; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
keywords: Atherosclerotic cardiovascular disease; Primary prevention; Risk stratification