Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran.
Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran.
Sci Rep. 2023 Aug 30;13(1):14229. doi: 10.1038/s41598-023-40820-3.
The Globorisk and WHO cardiovascular risk prediction models are country-specific and region-specific, respectively. The goal of this study was to assess the agreement and correlation between the WHO and Globorisk 10-year cardiovascular disease risk prediction models. The baseline data of 6796 individuals aged 40-74 years who participated in the Fasa cohort study without a history of cardiovascular disease or stroke at baseline were included. In the WHO and Globorisk models scores were calculated using age, sex, systolic blood pressure (SBP), current smoking, diabetes, and total cholesterol for laboratory-based risk and age, sex, SBP, current smoking, and body mass index (BMI) for non-laboratory-based risk (office-based or BMI-based). In Globorisk and WHO risk agreement across risk categories (low, moderate, and high) was examined using the kappa statistic. Also, Pearson correlation coefficients and scatter plots were used to assess the correlation between Globorisk and WHO models. Bland-Altman plots were presented for determination agreement between Globorisk and WHO risk scores in individual's level. In laboratory-based models, agreement across categories was substantial in the overall population (kappa values: 0.75) and also for females (kappa values: 0.74) and males (kappa values: 0.76), when evaluated separately. In non-laboratory-based models, agreement across categories was substantial for the whole population (kappa values: 0.78), and almost perfect for among males (kappa values: 0.82) and substantial for females (kappa values: 0.73). The results showed a very strong positive correlation (r ≥ 0.95) between WHO and Globorisk laboratory-based scores for the whole population, males, and females and also a very strong positive correlation (r > 0.95) between WHO and Globorisk non-laboratory-based scores for the whole population, males, and females. In the laboratory-based models, the limit of agreements was better in males (95%CI 2.1 to - 4.2%) than females (95%CI 4.3 to - 7.3%). Also, in the non-laboratory-based models, the limit of agreements was better in males (95%CI 2.9 to - 4.0%) than females (95%CI 3.2 to - 6.1%). There was a good agreement between both the laboratory-based and the non-laboratory-based WHO models and the Globorisk models. The correlation between two models was very strongly positive. However, in the Globorisk models, more people were in high-risk group than in the WHO models. The scatter plots and Bland-Altman plots showed systematic differences between the two scores that vary according to the level of risk. So, for these models may be necessary to modify the cut points of risk groups. The validity of these models must be determined for this population.
世界卫生组织（WHO）和 Globorisk 心血管风险预测模型分别是针对特定国家和特定地区的。本研究的目的是评估 WHO 和 Globorisk 10 年心血管疾病风险预测模型之间的一致性和相关性。本研究纳入了 6796 名年龄在 40-74 岁之间、基线时无心血管疾病或中风病史的 Fasa 队列研究参与者的基线数据。在 WHO 和 Globorisk 模型中，通过年龄、性别、收缩压（SBP）、当前吸烟、糖尿病和实验室风险的总胆固醇以及年龄、性别、SBP、当前吸烟和非实验室风险（办公室或 BMI 为基础）的体重指数（BMI）计算分数。在 Globorisk 和 WHO 风险分类（低、中、高）之间使用kappa 统计量评估风险协议。还使用 Pearson 相关系数和散点图评估了 Globorisk 和 WHO 模型之间的相关性。Bland-Altman 图用于确定个体水平上 Globorisk 和 WHO 风险评分之间的一致性。在基于实验室的模型中，整个人群（kappa 值：0.75）以及女性（kappa 值：0.74）和男性（kappa 值：0.76）的分类之间的一致性是适度的。在非实验室模型中，整个人群的分类之间的一致性是适度的（kappa 值：0.78），男性几乎是完美的（kappa 值：0.82），女性是适度的（kappa 值：0.73）。结果表明，整个人群、男性和女性的 WHO 和 Globorisk 基于实验室的评分之间存在很强的正相关（r≥0.95），整个人群、男性和女性的 WHO 和 Globorisk 非基于实验室的评分之间也存在很强的正相关（r>0.95）。在基于实验室的模型中，男性的一致性界限（95%CI：2.1 至-4.2%）优于女性（95%CI：4.3 至-7.3%）。此外，在非基于实验室的模型中，男性的一致性界限（95%CI：2.9 至-4.0%）优于女性（95%CI：3.2 至-6.1%）。基于实验室和非实验室的 WHO 模型与 Globorisk 模型之间存在良好的一致性。两种模型之间的相关性非常强。然而，在 Globorisk 模型中，高危人群比 WHO 模型中的更多。散点图和 Bland-Altman 图显示，两个评分之间存在系统差异，差异程度随风险水平而异。因此，对于这些模型，可能需要修改风险组的切点。必须针对该人群确定这些模型的有效性。
