Predicting coronary heart disease using risk assessment charts and risk factor categories

Background Cardiovascular disease is the leading cause of death and disability in Egypt. An appropriate estimation of risk is important to improve cardiovascular outcomes and ensure efficient allocation of resources used to support disease prevention. Risk prediction charts have been developed to provide clinicians with a simple tool to estimate the absolute risk of developing coronary heart disease (CHD). Objectives To test the accuracy of the World Health Organization/International Society of Hypertension (WHO/ISH) risk prediction charts in predicting and identifying people at risk of developing CHD and to propose an alternative risk assessment instrument based on simple laboratory tests, routine examination, and reported personal and medical data. Methods A cross-sectional screening survey was conducted at an emergency department of a health insurance hospital in Alexandria, Egypt. A total of 350 enrolled patients were evaluated clinically. We applied the WHO/ISH risk assessment chart for the Eastern Mediterranean region to test its accuracy in predicting CHD. Results The validation statistics indicated that the WHO/ISH risk prediction charts identified cases with CHD with 60.0% sensitivity and 93.2% specificity. At least nine risk factors for developing CHD were detected in all patients in the study cohort. Hypertension was the strongest predictor of CHD [odds ratio (OR) (95% confidence interval (CI)): 20.8 (5.6-76.9)]. Silent cardiovascular risk factors were ascertained in about 30% of the studied population, a finding that did not differ significantly by sex. We propose a different risk assessment model for general practice that incorporates standard cardiovascular risk factors, with or without laboratory tests. Conclusions Standard cardiovascular risk factors included in a simple risk prediction algorithm can predict multivariate CHD risk in apparently healthy individuals. Non-laboratory-based risk assessment models have no superior advantage over those employing laboratory investigations.