孟加拉国特定地区2型糖尿病患者的心血管风险评估：基于胆固醇的WHO/ISH、全球风险评估及弗明汉风险预测工具之间的一致性
Cardiovascular risk assessment among type-2 diabetic subjects in selected areas of Bangladesh: concordance among without cholesterol-based WHO/ISH, Globorisk, and Framingham risk prediction tools.
作者信息
Mondal Rajib, Ritu Rani Baroi, Banik Palash Chandra
机构信息
Department of Public Health, Hamdard University Bangladesh (HUB), Gazaria, Munshiganj, Bangladesh.
Department of Public Health and Research, Center for Noncommunicable Diseases Prevention Control Rehabilitation & Research (CeNoR), Dhaka, Bangladesh.
出版信息
Heliyon. 2021 Aug 5;7(8):e07728. doi: 10.1016/j.heliyon.2021.e07728. eCollection 2021 Aug.
INTRODUCTION
Cardiovascular disease (CVD) risk is higher among the subjects with type-2 diabetes mellitus (T2DM) in low- and middle-income countries, like Bangladesh. However, there is no relevant available online published data for this country. We aimed at assessing the 10-year CVD risk among T2DM subjects in selected areas of Bangladesh using the without cholesterol-based joint World Health Organization/International Society of Hypertension (WHO/ISH), Globorisk, and Framingham Risk Score (FRS) risk prediction tools, and also evaluating the concordance among these tools.
METHODS AND MATERIALS
In this paper, we extracted a total of 327 subjects (40-60 years aged) from an observational study with 356 subjects, excluding those with diagnosed CVDs. The subjects were selected conveniently from purposively selected respective diabetic hospitals of Pirojpur and Dinajpur districts. We used the required respective variables of WHO/ISH, Globorisk, and FRS tools to predict CVD risks. The risks were categorized as low (<10%), moderate (10-<20%), high (20-<30%) and very high (≥30%).
RESULTS
Subjects at moderate CVD risk were much higher identified by Globorisk (37.0%) and FRS (38.8%) compared to WHO/ISH (15.3%), and the same scenarios have also been observed for high (13.5%, 19.3% and 2.4%, respectively) and very high (5.5%, 17.4% and 1.8%, respectively) risks. There was fair level of concordance between WHO/ISH and Globorisk (PABAK-OS = 0.37; 95% CI 0.33-0.42; < 0.001), and Globorisk and FRS (PABAK-OS = 0.34; 95% CI 0.30-0.39; < 0.001). And, between WHO/ISH and FRS, it was none to slight level (PABAK-OS = 0.09, 95% CI 0.04-0.14; = 0.001).
CONCLUSIONS
A significant proportion of the selected study subjects is at moderate to very high risk of developing CVDs predicted especially by Globorisk and FRS compared to WHO/ISH, indicating low concordance. With and without cholesterol-based studies can answer the problem more clearly.
引言
在孟加拉国等低收入和中等收入国家，2型糖尿病（T2DM）患者的心血管疾病（CVD）风险更高。然而，该国尚无相关的在线公开数据。我们旨在使用基于无胆固醇的世界卫生组织/国际高血压学会（WHO/ISH）联合模型、全球风险模型和弗明汉风险评分（FRS）风险预测工具，评估孟加拉国选定地区T2DM患者的10年CVD风险，并评估这些工具之间的一致性。
方法和材料
在本文中，我们从一项对356名受试者的观察性研究中总共提取了327名受试者（年龄在40 - 60岁之间），排除了那些已诊断患有CVD的受试者。这些受试者是从皮罗杰布尔和迪纳杰布尔地区有目的地挑选的各糖尿病医院中方便选取的。我们使用WHO/ISH、全球风险模型和FRS工具所需的各自变量来预测CVD风险。风险被分类为低（<10%）、中（10 - <20%）、高（20 - <30%）和非常高（≥30%）。
结果
与WHO/ISH（15.3%）相比，全球风险模型（37.0%）和FRS（38.8%）识别出的中度CVD风险受试者要多得多，对于高风险（分别为13.5%、19.3%和2.4%）和非常高风险（分别为5.5%、17.4%和1.8%）的情况也观察到了相同的现象。WHO/ISH与全球风险模型之间存在中等程度的一致性（PABAK - OS = 0.37；95% CI 0.33 - 0.42；<0.001），全球风险模型与FRS之间也存在中等程度的一致性（PABAK - OS = 0.34；95% CI 0.30 - 0.39；<0.001）。而WHO/ISH与FRS之间的一致性处于无到轻微程度（PABAK - OS = 0.09，95% CI 0.04 - 0.14；= 0.001）。
结论
与WHO/ISH相比，特别是全球风险模型和FRS预测，所选研究受试者中有很大一部分处于发展为CVD的中度至非常高风险，表明一致性较低。有胆固醇和无胆固醇的研究可以更清楚地回答这个问题。
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