title: Total cardiovascular risk for next 10 years among rural population of Nepal using WHO/ISH risk prediction chart.
abstract: BACKGROUND
  Cardiovascular diseases (CVD) are the leading cause of morbidity and mortality globally. Primary prevention of CVD based on total CVD risk approach using WHO/ISH risk prediction chart would be more effective to stratify population under different risk levels, prioritize and utilize the scarce resources of low and middle-income countries. This study estimated total 10-year CVD risk and determined the proportion of population who need immediate drug therapy among the rural population of Nepal.
  
  
  METHODS
  A community based cross-sectional study conducted among 345 participants aged 40-80 years in rural villages of Lamjung District of Nepal. They were selected randomly from total eighteen wards. Data were collected using WHO STEPS questionnaires. WHO/ISH risk prediction chart for SEAR D was used to estimate total cardiovascular risk. Chi-square and independent t-test were used to test significance at the level of p < 0.05 in SPSS version 16.0.
  
  
  RESULTS
  Of the total participants, 55.4% were female. The mean age (standard deviation) of the participants was 53.5 ± 10.1 years. According to WHO/ISH chart proportions of low, moderate and high CVD risk were 86.4%, 9.3%, and 4.3%, respectively. Eleven percent of participants were in need of immediate pharmacotherapy. Age (p = 0.001), level of education (p = 0.01) and occupation (p = 0.001) were significantly associated with elevated CVD risk.
  
  
  CONCLUSIONS
  A large proportion of Nepalese rural population is at moderate and high CVD risk. Immediate pharmacological interventions are warranted for at least one in every ten individuals along with lifestyle interventions. Both population-wise and high-risk approaches are required to minimize CVD burden in the future.
authors.affiliation: Bangladesh Institute of Health Sciences (BIHS), Dhaka, Bangladesh. drmkkhanal@gmail.com.
authors.forename: Mahesh Kumar
authors.initials: MK
authors.lastname: Khanal
authors.affiliation: Department of Community Medicine, Bangladesh Institute of Health Sciences, Dhaka, Bangladesh.
authors.forename: M S A Mansur
authors.initials: MS
authors.lastname: Ahmed
authors.affiliation: Department of Community Medicine, Bangladesh Institute of Health Sciences, Dhaka, Bangladesh.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Moniruzzaman
authors.affiliation: Department of Community Medicine, Bangladesh Institute of Health Sciences, Dhaka, Bangladesh.
authors.forename: Palash Chandra
authors.initials: PC
authors.lastname: Banik
authors.affiliation: Bangladesh Institute of Health Sciences (BIHS), Dhaka, Bangladesh.
authors.forename: Raja Ram
authors.initials: RR
authors.lastname: Dhungana
authors.affiliation: Padmakanya Multiple Campus, Tribhuvan University (TU), Kathmandu, Nepal.
authors.forename: Pratiksha
authors.initials: P
authors.lastname: Bhandari
authors.affiliation: Institute of Medicine (IOM), Tribhuvan University, Kathmandu, Nepal.
authors.forename: Surya
authors.initials: S
authors.lastname: Devkota
authors.affiliation: Institute of Medicine (IOM), Tribhuvan University, Kathmandu, Nepal.
authors.forename: Arun
authors.initials: A
authors.lastname: Shayami
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009390:Nepal / Q000453:epidemiology; D015995:Prevalence; D011322:Primary Prevention / Q000379:methods*; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D012424:Rural Population; D012923:Social Class; D011795:Surveys and Questionnaires; D014944:World Health Organization
keywords: Cardiovascular diseases; Risk prediction; Rural population; Total 10-year CVD risk; WHO/ISH chart