PMID- 35459666 OWN - NLM STAT- MEDLINE DCOM- 20220426 LR - 20220716 IS - 2044-6055 (Electronic) IS - 2044-6055 (Linking) VI - 12 IP - 4 DP - 2022 Apr 22 TI - Absolute cardiovascular risk scores and medication use in rural India: a cross-sectional study. PG - e054617 LID - 10.1136/bmjopen-2021-054617 [doi] LID - e054617 AB - OBJECTIVES: We compared the performance of laboratory-based cardiovascular risk prediction tools in a low-income and middle-income country setting, and estimated the use of antihypertensive and lipid-lowering medications in those deemed at high risk of a cardiovascular event. DESIGN: A cross-sectional study. SETTING: The study population comprised adult residents (aged >/=18 years) of the Rishi Valley region located in Chittoor District, south-western Andhra Pradesh, India. PARTICIPANTS: 7935 participants were surveyed between 2012 and 2015. We computed the 10-year cardiovascular risk and undertook pair-to-pair analyses between various risk tools used to predict a fatal or non-fatal cardiovascular event (Framingham Risk Score (FRS), World Health Organization Risk Score (WHO-RS) and Australian Risk Score (ARS)), or a fatal cardiovascular event (Systematic COronary Risk Evaluation (SCORE-high and SCORE-low)). Concordance was assessed by ordinary least-products (OLP) regression (for risk score) and quadratic weighted kappa (kappa(w), for risk category). RESULTS: Of participants aged 35-74 years, 3.5% had prior cardiovascular disease. The relationships between risk scores were quasi-linear with good agreement between the FRS and ARS (OLP slope=0.96, kappa(w)=0.89). However, the WHO-RS underestimated cardiovascular risk compared with all other tools. Twenty per cent of participants had >/=20% risk of an event using the ARS; 5% greater than the FRS and nearly threefold greater than the WHO-RS. Similarly, 16% of participants had a risk score >/=5% using SCORE-high which was 6% greater than for SCORE-low. Overall, absolute cardiovascular risk increased with age and was greater in men than women. Only 9%-12% of those deemed 'high risk' were taking lipid-lowering or antihypertensive medication. CONCLUSIONS: Cardiovascular risk prediction tools perform disparately in this setting of disadvantage. Few deemed at high risk were receiving the recommended treatment. CI - (c) Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. FAU - Birhanu, Mulugeta Molla AU - Birhanu MM AUID- ORCID: 0000-0003-0364-279X AD - Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Victoria, Australia. FAU - Evans, Roger G AU - Evans RG AD - Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Clayton, Victoria, Australia. FAU - Zengin, Ayse AU - Zengin A AUID- ORCID: 0000-0001-6428-6165 AD - Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Victoria, Australia. FAU - Riddell, Michaela AU - Riddell M AD - Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Victoria, Australia. FAU - Kalyanram, Kartik AU - Kalyanram K AD - Rishi Valley Rural Health Centre, Chittoor District, Andhra Pradesh, India. FAU - Kartik, Kamakshi AU - Kartik K AD - Rishi Valley Rural Health Centre, Chittoor District, Andhra Pradesh, India. FAU - Suresh, Oduru AU - Suresh O AD - Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Victoria, Australia. AD - Rishi Valley Rural Health Centre, Chittoor District, Andhra Pradesh, India. FAU - Thomas, Nihal Jacob AU - Thomas NJ AD - Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India. FAU - Srikanth, Velandai K AU - Srikanth VK AD - Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Victoria, Australia. AD - Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia. FAU - Thrift, Amanda G AU - Thrift AG AUID- ORCID: 0000-0001-8533-4170 AD - Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Victoria, Australia amanda.thrift@monash.edu. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20220422 PL - England TA - BMJ Open JT - BMJ open JID - 101552874 RN - 0 (Antihypertensive Agents) RN - 0 (Lipids) SB - IM MH - Adolescent MH - Adult MH - Antihypertensive Agents/therapeutic use MH - Australia MH - *Cardiovascular Diseases/epidemiology MH - Cross-Sectional Studies MH - Female MH - Heart Disease Risk Factors MH - Humans MH - India/epidemiology MH - Lipids MH - Male MH - Risk Assessment MH - Risk Factors PMC - PMC9036467 OTO - NOTNLM OT - cardiac epidemiology OT - epidemiology OT - preventive medicine OT - public health COIS- Competing interests: Professor Thrift reports grants from the National Health and Medical Research Council of Australia (GNT1042600, GNT1005740, GNT1040030, GNT1122455, GNT1171966, GNT1143155, and GNT1182017), Stroke Foundation Australia (SG1807), and Heart Foundation, Australia (VG102282) for this study and for other projects outside the submitted work. EDAT- 2022/04/24 06:00 MHDA- 2022/04/27 06:00 PMCR- 2022/04/22 CRDT- 2022/04/23 05:20 PHST- 2022/04/23 05:20 [entrez] PHST- 2022/04/24 06:00 [pubmed] PHST- 2022/04/27 06:00 [medline] PHST- 2022/04/22 00:00 [pmc-release] AID - bmjopen-2021-054617 [pii] AID - 10.1136/bmjopen-2021-054617 [doi] PST - epublish SO - BMJ Open. 2022 Apr 22;12(4):e054617. doi: 10.1136/bmjopen-2021-054617.