Comparison of Cardiovascular Risk Estimation Tools in Thai Hospital Employees

Main Article Content

Apichard Sukontasarn, MD
Warut Chaiwong, BSc, MPH
Khajornsak Thepsen, MD
Prinya Chomsang, MD
Manoon Samranthin, MD
Thouantosaporn Suwanjutah, MD
Chokechai Suwannakijboriharn, MD
Worapaka Manosroi, MD
Jutarut Saikam, BNS, MSc
Chulathip Boonma, MPH
Chaiyos Kunanusont, MD,PhD

Abstract

OBJECTIVES: To compare cardiovascular disease (CVD) risks estimated by various estimators, we collected and analyzed the annual health checkup data of nonphysician hospital employees (NPHEs) in 5 private hospitals in Thailand in 2018.


MATERIALS AND METHODS: This cross-sectional study employed five commonly used CVD risk calculators Thai Cardiovascular (CV) Risk score, modified Coronary Risk Chart (mCRC), Systematic Coronary Risk Evaluation (SCORE) chart, World Health Organization-Southeast Asian Region B (WHO SEAR B) risk prediction chart, and atherosclerotic cardiovascular disease (ASCVD) risk estimator plus) to compare risk levels estimated by each method. Statistical analysis was conducted using R code and STATA.


RESULTS: Among 7,286 eligible NPHEs invited to join, 3,687 consented to join. A total of 2,907 subjects were included in this study after excluding those with inadequate data and those with existing CVD. The majority (84.7%) of subjects were female and 75.3% of subjects were in the 30-59 years’ age group. More than half (64.6%) had normal Body Mass Index (BMI). A small proportion had pre-existing hypertension (16.4%), diabetes mellitus (7.9%) and very few reported smoking behavior (5.1%) while a quarter (24.2%) reported regular alcohol use and 60.6% reported sedentary life. Pairwise comparison of future 10-year CVD risks between Thai CV Risk Score and (i) mCRC, (ii) European SCORE, (iii) WHO SEAR B risk chart and, (iv) ASCVD Risk Estimator Plus showed significant agreement of 94.15%, 98.25%, 97.80%, and 98.83% respectively, all with p < 0.001. Comparing results of Thai CV Risk Score when lipid profiles was used and not used also revealed high agreement (88.72%), p < 0.001. Subgroup comparison among those with moderate to high risks, agreement between Thai CV Risk Score with m-CRC, European SCORE, WHO SEAR-B and ASCVD Risk Estimator Plus dropped dramatically to 47.1%, 78.6%, 20.0%, and 41.7% respectively.


CONCLUSION: This study shows significant agreement between the Thai CV Risk Score with lipid profiles and mCRC, European SCORE Chart, WHO SEAR B, ASCVD Risk Estimator Plus and Thai CV Risk Score without lipid profiles. The Thai CV Risk Score could numerically detect more persons with moderate or high cardiovascular risk than other risk calculators. Clinical recommendation for those with moderate or even low risk should be made carefully, taking into account that the patient might actually be at a higher risk level.

Downloads

Download data is not yet available.

Article Details

How to Cite
1.
Sukontasarn, MD A, Chaiwong, BSc, MPH W, Thepsen, MD K, Chomsang, MD P, Samranthin, MD M, Suwanjutah, MD T, Suwannakijboriharn, MD C, Manosroi, MD W, Saikam, BNS, MSc J, Boonma, MPH C, Kunanusont, MD,PhD C. Comparison of Cardiovascular Risk Estimation Tools in Thai Hospital Employees. BKK Med J [Internet]. 2021Sep.29 [cited 2021Oct.22];17(2):93. Available from: https://he02.tci-thaijo.org/index.php/bkkmedj/article/view/248114
Section
Original Article

References

1. Ohira T, Iso H. Cardiovascular disease epidemiology in Asia: an overview. Circ J 2013;77:1646-52.
2. Aekplakorn W, Hathaichanok P, Kanittha T, et al. The 5th National Health Examination Survey, 2014. Nonthaburi: Health System Research Institute; 2016.
3. Thawornchaisit P, Delooze F, Reid CM, et al. Thai Cohort Study Team, Health risk factors and the incidence of hypertension: 4-year prospective findings from a national cohort of 60590 Thai Open University students. BMJ Open 2013;3(6):e002826. doi:10.1136/BMJopen-2013-002826.
4. Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019;140:e596-e646. DOI:10.1161/CIR.0000000000000678.
5. Umemura S, Arima H, Arima S, et al. The Japanese society of hypertension guidelines for the management of hypertension (JSH 2019). Hypertens Res 2019;42:1235-481. DOI:10.1038/s41440-019-0284-9.
6. Breswick AD, Brindle P, Fahey T, et al. A systematic review of risk scoring methods and clinical decision aids used in the primary prevention of coronary heart disease. London, UK: National Collaborating Centre for Primary Care and Royal College of General Practitioners; 2008.
7. VanDieren S, Beulens JW, Kengne AP, et al. Prediction models for the risk of cardiovascular disease in patients with type 2 diabetes: a systemic review. Heart 2012;98:360-9. doi:10.1136/heartjnl-2011-300734.
8. Srittara P, Cheepudomwith S, Chapman N, et al. Twelve-year changes in vascular risk factors and their associations with mortality in a cohort of 3,499 Thais: The electricity generating authority of Thailand study. Int J Epidemiol 2003;32:461-8. doi:10.1093/ije/dyg105.
9. Vathesatogkit P, Woodward M, Thanomsup S, et al. Cohort profile: The electricity generating authority of Thailand study. Int J Epidemiol 2012;41:359-65. DOI: 10.1093/ije/dyq218.
10. Conroy RM, Pyorala K, Fitzgerald AP, et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J 2003;24:987-1003. doi:10.1016/ s0195-668x(03)00114-3.
11. World Health Organization. Prevention of cardiovascular disease; pocket guidelines for assessment and management of cardiovascular risk: WHO/ISH Cardiovascular Risk Prediction Chart for WHO epidemiological sub-regions SEAR B, SEAR D). Geneva: WHO Press; 2007:1-30.
12. Andrus B, Lacaille D. 2013 ACC/AHA guideline on the assessment of cardiovascular risk. J Am Coll Cardiol 2014;63(25 Pt A):2886. doi:10.1016/j.jacc.2014.02.606.
13. Pyorala K, De Backer G, Graham I, et al. Prevention of coronary heart disease in clinical practice. Recommendations of the Task Force of the European Society of Cardiology, European Atherosclerosis Society, and European Society of Hypertension. Eur Heart J 1994;15:1300-31. doi: 10.1093/ oxford journals.eurheartj.a060388.
14. Anderson KM, Wilson PWF, Odell PM, et al. An updated coronary risk profile: A statement for health professionals. Circulation 1991;83:356-62. doi:10.1161/01.cir.83.1.356.
15. Veerakul G, Nootaro A, Damrongrat B, et al. Five-year outcome of primary cardiovascular prevention in air force officers. Asian Heart J 2012;20:1-11.
16. Veerakul G, Khajornyai A, Wongkasia S, et al. Predicting and preventing cardiovascular events in asymptomatic patients: A 10-year prospective study. BKK Med J 2017;13:1-12.

Most read articles by the same author(s)