title: Laboratory-based and office-based risk scores and charts to predict 10-year risk of cardiovascular disease in 182 countries: a pooled analysis of prospective cohorts and health surveys.
abstract: Worldwide implementation of risk-based cardiovascular disease (CVD) prevention requires risk prediction tools that are contemporarily recalibrated for the target country and can be used where laboratory measurements are unavailable. We present two cardiovascular risk scores, with and without laboratory-based measurements, and the corresponding risk charts for 182 countries to predict 10-year risk of fatal and non-fatal CVD in adults aged 40-74 years.
  
  
  
  Based on our previous laboratory-based prediction model (Globorisk), we used data from eight prospective studies to estimate coefficients of the risk equations using proportional hazard regressions. The laboratory-based risk score included age, sex, smoking, blood pressure, diabetes, and total cholesterol; in the non-laboratory (office-based) risk score, we replaced diabetes and total cholesterol with BMI. We recalibrated risk scores for each sex and age group in each country using country-specific mean risk factor levels and CVD rates. We used recalibrated risk scores and data from national surveys (using data from adults aged 40-64 years) to estimate the proportion of the population at different levels of CVD risk for ten countries from different world regions as examples of the information the risk scores provide; we applied a risk threshold for high risk of at least 10% for high-income countries (HICs) and at least 20% for low-income and middle-income countries (LMICs) on the basis of national and international guidelines for CVD prevention. We estimated the proportion of men and women who were similarly categorised as high risk or low risk by the two risk scores.
  
  
  
  Predicted risks for the same risk factor profile were generally lower in HICs than in LMICs, with the highest risks in countries in central and southeast Asia and eastern Europe, including China and Russia. In HICs, the proportion of people aged 40-64 years at high risk of CVD ranged from 1% for South Korean women to 42% for Czech men (using a ≥10% risk threshold), and in low-income countries ranged from 2% in Uganda (men and women) to 13% in Iranian men (using a ≥20% risk threshold). More than 80% of adults were similarly classified as low or high risk by the laboratory-based and office-based risk scores. However, the office-based model substantially underestimated the risk among patients with diabetes.
  
  
  
  Our risk charts provide risk assessment tools that are recalibrated for each country and make the estimation of CVD risk possible without using laboratory-based measurements.
  
  
  
  National Institutes of Health.
authors.affiliation: Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Peter
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authors.lastname: Ueda
authors.affiliation: The George Institute for Global Health, University of Oxford, Oxford, UK; The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia; Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Woodward
authors.affiliation: Yale/Yale-New Haven Hospital, Center for Outcomes Research and Evaluation, New Haven, CT, USA.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Lu
authors.affiliation: Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Kaveh
authors.initials: K
authors.lastname: Hajifathalian
authors.affiliation: Central Department of Primary Health Care, Ministry of Health, Kuwait City, Kuwait.
authors.forename: Rihab
authors.initials: R
authors.lastname: Al-Wotayan
authors.affiliation: Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición, "Salvador Zubirán", Mexico City, Mexico.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Aguilar-Salinas
authors.affiliation: MRC-PHE Centre for Environment and Health, Imperial College London, London, UK; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Ahmadvand
authors.affiliation: Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Fereidoun
authors.initials: F
authors.lastname: Azizi
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
authors.forename: James
authors.initials: J
authors.lastname: Bentham
authors.affiliation: Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer Hospital, Prague, Czech Republic.
authors.forename: Renata
authors.initials: R
authors.lastname: Cifkova
authors.affiliation: MRC-PHE Centre for Environment and Health, Imperial College London, London, UK; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; Department of Natural Sciences, School of Science and Technology, Middlsex University, London, UK.
authors.forename: Mariachiara
authors.initials: M
authors.lastname: Di Cesare
authors.affiliation: National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
authors.forename: Louise
authors.initials: L
authors.lastname: Eriksen
authors.affiliation: Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Farshad
authors.initials: F
authors.lastname: Farzadfar
authors.affiliation: Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica.
authors.forename: Trevor S
authors.initials: TS
authors.lastname: Ferguson
authors.affiliation: Center for International Collaboration and Partnership, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan.
authors.forename: Nayu
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authors.lastname: Ikeda
authors.affiliation: Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Davood
authors.initials: D
authors.lastname: Khalili
authors.affiliation: Institute of Health Policy and Management, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Young-Ho
authors.initials: YH
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authors.affiliation: Statistical Unit, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Vera
authors.initials: V
authors.lastname: Lanska
authors.affiliation: Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/Idipaz, and CIBER of Epidemiology and Public Health, Madrid, Spain.
authors.forename: Luz
authors.initials: L
authors.lastname: León-Muñoz
authors.affiliation: Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia.
authors.forename: Dianna J
authors.initials: DJ
authors.lastname: Magliano
authors.affiliation: Department of Public Health, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile.
authors.forename: Paula
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authors.lastname: Margozzini
authors.affiliation: WHO, Malawi Country Office, Lilongwe, Malawi.
authors.forename: Kelias P
authors.initials: KP
authors.lastname: Msyamboza
authors.affiliation: Non-communicable Diseases Prevention and Control Program at the Ministry of Health, Kampala, Uganda.
authors.forename: Gerald
authors.initials: G
authors.lastname: Mutungi
authors.affiliation: Division of Health and Nutrition Survey, Korea Centers for Disease Control and Prevention, Cheongwon-gun, South Korea.
authors.forename: Kyungwon
authors.initials: K
authors.lastname: Oh
authors.affiliation: University of Health Sciences, Phnom Penh, Cambodia.
authors.forename: Sophal
authors.initials: S
authors.lastname: Oum
authors.affiliation: Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/Idipaz, and CIBER of Epidemiology and Public Health, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Rodríguez-Artalejo
authors.affiliation: Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Publica, Cuernavaca, Mexico.
authors.forename: Rosalba
authors.initials: R
authors.lastname: Rojas-Martinez
authors.affiliation: División Salud Pública y Medicina Familiar, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Valdivia
authors.affiliation: Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica.
authors.forename: Rainford
authors.initials: R
authors.lastname: Wilks
authors.affiliation: Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia.
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Shaw
authors.affiliation: Department of Information, Evidence and Research, WHO, Geneva, Switzerland.
authors.forename: Gretchen A
authors.initials: GA
authors.lastname: Stevens
authors.affiliation: National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
authors.forename: Janne S
authors.initials: JS
authors.lastname: Tolstrup
authors.affiliation: MRC-PHE Centre for Environment and Health, Imperial College London, London, UK; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
authors.forename: Bin
authors.initials: B
authors.lastname: Zhou
authors.affiliation: Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Salomon
authors.affiliation: MRC-PHE Centre for Environment and Health, Imperial College London, London, UK; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; WHO Collaborating Centre on NCD Surveillance and Epidemiology, Imperial College London, London, UK; Wellcome Trust Centre for Global Health Research, London, UK.
authors.forename: Majid
authors.initials: M
authors.lastname: Ezzati
authors.affiliation: Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA. Electronic address: gdanaei@hsph.harvard.edu.
authors.forename: Goodarz
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mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D014943:Global Health; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors