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Published in: BMC Public Health 1/2024

Open Access 01-12-2024 | Research

Recalibration of Framingham risk for a local population of Sri Lanka

Authors: Sameera Upashantha Ranasinghe, E. M. D. S. Ekanayake, Laksitha Iroshan Ranasinghe, Sampath U. B. Tennakoon

Published in: BMC Public Health | Issue 1/2024

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Abstract

Background

Cardiovascular Diseases (CVD) account for the highest number of deaths and disability globally and within Sri Lanka. A CVD risk prediction tool is a simple means of early identification of high-risk groups which is a cost-effective preventive strategy, especially for resource-poor countries. Distribution of risk factor levels varies in different regions even within the same country, thus a common risk estimation tool for the country may give false local predictions. Since there are few published data related to Sri Lanka the aim of this study was to recalibrate the Framingham equation according to the local risk factor profile of a population in the Kurunegala region in Sri Lanka.

Method

A cross-sectional study was conducted with the participation of 1 102 persons from the Kurunegala Regional Director of Health Services area and the data was collected using an interviewer-administered questionnaire, anthropometric, blood pressure, and biochemical measurements. CVD risk was estimated using Framingham original and recalibrated CVD risk assessment methods. Current CVD mortality and morbidity data and the recalibration method conducted by the method described by Wilson and colleagues were used for calculations.

Results

Original and recalibrated Framingham CVD risk scores predicted 55.5% (N = 612) and 62.3% (N = 687) to be having less than 10% CVD risk respectively. Further, the original and recalibrated CVD Risk Scores predicted 2.2% (N = 24) and 1.8% (N = 20) to be having CVD risk more than 40% respectively.

Conclusion

These findings show an over prediction of the CVD risk with the original Framingham risk calculations which signifies the importance of development of a region-specific risk prediction tool using local risk factor data in Sri Lanka which will prevent unnecessary expenditure to manage people without risk of CVD.
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Literature
4.
go back to reference Weeratunga MK. Population ageing and emerging intergenerational inequalities in Sri Lanka. Int J Adv Res Rev. 2018;3:9–17. Weeratunga MK. Population ageing and emerging intergenerational inequalities in Sri Lanka. Int J Adv Res Rev. 2018;3:9–17.
5.
go back to reference Chiu M, Austin PC, Manuel DG, Tu JV. Comparison of cardiovascular risk profiles among ethnic groups using population health surveys between 1996 and 2007. CMAJ. 2010;182(8):E301–10.CrossRefPubMedPubMedCentral Chiu M, Austin PC, Manuel DG, Tu JV. Comparison of cardiovascular risk profiles among ethnic groups using population health surveys between 1996 and 2007. CMAJ. 2010;182(8):E301–10.CrossRefPubMedPubMedCentral
6.
go back to reference Ho FK, Gray SR, Welsh P, Gill JMR, Sattar N, Pell JP, et al. Ethnic differences in cardiovascular risk: examining differential exposure and susceptibility to risk factors. BMC Med. 2022;20(1):149.CrossRefPubMedPubMedCentral Ho FK, Gray SR, Welsh P, Gill JMR, Sattar N, Pell JP, et al. Ethnic differences in cardiovascular risk: examining differential exposure and susceptibility to risk factors. BMC Med. 2022;20(1):149.CrossRefPubMedPubMedCentral
7.
go back to reference Joshi P, Islam S, Pais P, Reddy S, Dorairaj P, Kazmi K, et al. Risk factors for early myocardial infarction in South Asians compared with individuals in other countries. JAMA. 2007;297(3):286–94.CrossRefPubMed Joshi P, Islam S, Pais P, Reddy S, Dorairaj P, Kazmi K, et al. Risk factors for early myocardial infarction in South Asians compared with individuals in other countries. JAMA. 2007;297(3):286–94.CrossRefPubMed
8.
go back to reference Anand SS, Yusuf S, Vuksan V, Devanesen S, Teo KK, Montague PA, et al. Differences in risk factors, atherosclerosis, and cardiovascular disease between ethnic groups in Canada: the Study of Health Assessment and Risk in Ethnic groups (SHARE). The lancet. 2000;356(9226):279–84.CrossRef Anand SS, Yusuf S, Vuksan V, Devanesen S, Teo KK, Montague PA, et al. Differences in risk factors, atherosclerosis, and cardiovascular disease between ethnic groups in Canada: the Study of Health Assessment and Risk in Ethnic groups (SHARE). The lancet. 2000;356(9226):279–84.CrossRef
9.
go back to reference Cappuccio FP, Cook DG, Atkinson RW, Strazzullo P. Prevalence, detection, and management of cardiovascular risk factors in different ethnic groups in south London. Heart. 1997;78(6):555–63.CrossRefPubMedPubMedCentral Cappuccio FP, Cook DG, Atkinson RW, Strazzullo P. Prevalence, detection, and management of cardiovascular risk factors in different ethnic groups in south London. Heart. 1997;78(6):555–63.CrossRefPubMedPubMedCentral
10.
go back to reference Rabanal KS, Lindman AS, Selmer RM, Aamodt G. Ethnic differences in risk factors and total risk of cardiovascular disease based on the Norwegian CONOR study. Eur J Prev Cardiol. 2013;20(6):1013–21.CrossRefPubMed Rabanal KS, Lindman AS, Selmer RM, Aamodt G. Ethnic differences in risk factors and total risk of cardiovascular disease based on the Norwegian CONOR study. Eur J Prev Cardiol. 2013;20(6):1013–21.CrossRefPubMed
11.
go back to reference Patel DJ, Winterbotham M, Britt RP, Sutton GC, Bhatnagar D, Mackness MI, et al. Coronary risk factors in people from the Indian subcontinent living in West London and their siblings in India. The Lancet. 1995;345(8947):405–9.CrossRef Patel DJ, Winterbotham M, Britt RP, Sutton GC, Bhatnagar D, Mackness MI, et al. Coronary risk factors in people from the Indian subcontinent living in West London and their siblings in India. The Lancet. 1995;345(8947):405–9.CrossRef
12.
go back to reference WHO. Non Communicable Disease Risk Factor Survey Sri Lanka 2015. 2015. WHO. Non Communicable Disease Risk Factor Survey Sri Lanka 2015. 2015.
13.
go back to reference Anderson KM, Odell PM, Wilson PW, Kannel WB. Cardiovascular disease risk profiles. Am Heart J. 1991;121(1):293–8.CrossRefPubMed Anderson KM, Odell PM, Wilson PW, Kannel WB. Cardiovascular disease risk profiles. Am Heart J. 1991;121(1):293–8.CrossRefPubMed
14.
go back to reference Chow CK, Joshi R, Celermajer DS, Patel A, Neal BC. Recalibration of a Framingham risk equation for a rural population in India. J Epidemiol Community Health. 2009;63(5):379–85.CrossRefPubMed Chow CK, Joshi R, Celermajer DS, Patel A, Neal BC. Recalibration of a Framingham risk equation for a rural population in India. J Epidemiol Community Health. 2009;63(5):379–85.CrossRefPubMed
15.
go back to reference Hua X, McDermott R, Lung T, Wenitong M, Tran-Duy A, Li M, et al. Validation and recalibration of the Framingham cardiovascular disease risk models in an Australian Indigenous cohort. Eur J Prev Cardiol. 2017;24(15):1660–9.CrossRefPubMedPubMedCentral Hua X, McDermott R, Lung T, Wenitong M, Tran-Duy A, Li M, et al. Validation and recalibration of the Framingham cardiovascular disease risk models in an Australian Indigenous cohort. Eur J Prev Cardiol. 2017;24(15):1660–9.CrossRefPubMedPubMedCentral
16.
go back to reference Marrugat J, d’Agostino R, Sullivan L, Elosua R, Wilson P, Ordovas J, et al. An adaptation of the Framingham coronary heart disease risk function to European Mediterranean areas. J Epidemiol Community Health. 2003;57(8):634–8.CrossRefPubMedPubMedCentral Marrugat J, d’Agostino R, Sullivan L, Elosua R, Wilson P, Ordovas J, et al. An adaptation of the Framingham coronary heart disease risk function to European Mediterranean areas. J Epidemiol Community Health. 2003;57(8):634–8.CrossRefPubMedPubMedCentral
17.
go back to reference Lwanga SK, Lemeshow S, Organization WH. Sample size determination in health studies: a practical manual. Geneva: World Health Organization; 1991. Lwanga SK, Lemeshow S, Organization WH. Sample size determination in health studies: a practical manual. Geneva: World Health Organization; 1991.
19.
go back to reference Cohen S, Lichtenstein E. Perceived stress, quitting smoking, and smoking relapse. Health Psychol. 1990;9(4):466.CrossRefPubMed Cohen S, Lichtenstein E. Perceived stress, quitting smoking, and smoking relapse. Health Psychol. 1990;9(4):466.CrossRefPubMed
21.
go back to reference Ministry of Health. Food Based Dietary Guidelines for Sri Lankans - Practitioner’s Handbook. 2021. Ministry of Health. Food Based Dietary Guidelines for Sri Lankans - Practitioner’s Handbook. 2021.
22.
go back to reference Forde C. Scoring the international physical activity questionnaire (IPAQ). Dublin: University of Dublin. 2018;3. Forde C. Scoring the international physical activity questionnaire (IPAQ). Dublin: University of Dublin. 2018;3.
23.
go back to reference Wilson PW, D’Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation. 1998;97(18):1837–47.CrossRefPubMed Wilson PW, D’Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation. 1998;97(18):1837–47.CrossRefPubMed
24.
go back to reference D’Agostino RB, Grundy S, Sullivan LM, Wilson P, Group CRP. Validation of the Framingham coronary heart disease prediction scores: results of a multiple ethnic groups investigation. JAMA. 2001;286(2):180–7.CrossRef D’Agostino RB, Grundy S, Sullivan LM, Wilson P, Group CRP. Validation of the Framingham coronary heart disease prediction scores: results of a multiple ethnic groups investigation. JAMA. 2001;286(2):180–7.CrossRef
25.
go back to reference D'Agostino RB Sr, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, Kannel WB. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 2008;117(6):743–53. D'Agostino RB Sr, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, Kannel WB. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 2008;117(6):743–53.
27.
go back to reference Mettananda KCD, Gunasekara N, Thampoe R, Madurangi S, Pathmeswaran A. Place of cardiovascular risk prediction models in South Asians; agreement between Framingham risk score and WHO/ISH risk charts. Int J Clin Pract. 2021;75(7):e14190.CrossRefPubMed Mettananda KCD, Gunasekara N, Thampoe R, Madurangi S, Pathmeswaran A. Place of cardiovascular risk prediction models in South Asians; agreement between Framingham risk score and WHO/ISH risk charts. Int J Clin Pract. 2021;75(7):e14190.CrossRefPubMed
28.
go back to reference Ranawaka U, Wijekoon C, Pathmeswaran A, Kasturiratne A, Gunasekara D, Chackrewarthy S, et al. Risk estimates of cardiovascular diseases in a Sri Lankan community. 2016. Ranawaka U, Wijekoon C, Pathmeswaran A, Kasturiratne A, Gunasekara D, Chackrewarthy S, et al. Risk estimates of cardiovascular diseases in a Sri Lankan community. 2016.
29.
go back to reference Al-Lawati JA, Barakat MN, Al-Lawati NA, Al-Maskari MY, Elsayed MK, Mikhailidis DP, et al. Cardiovascular risk assessment in diabetes mellitus: comparison of the general Framingham risk profile versus the world health organization/international society of hypertension risk prediction charts in Arabs—clinical implications. SAGE Publications Sage CA: Los Angeles, CA; 2013. p. 336–42. Al-Lawati JA, Barakat MN, Al-Lawati NA, Al-Maskari MY, Elsayed MK, Mikhailidis DP, et al. Cardiovascular risk assessment in diabetes mellitus: comparison of the general Framingham risk profile versus the world health organization/international society of hypertension risk prediction charts in Arabs—clinical implications. SAGE Publications Sage CA: Los Angeles, CA; 2013. p. 336–42.
30.
go back to reference Bansal P, Chaudhary A, Wander P, Satija M, Sharma S, Girdhar S, et al. Cardiovascular risk assessment using WHO/ISH risk prediction charts in a rural area of North India. J Res Med Dent Sci. 2016;4(2):127–31.CrossRef Bansal P, Chaudhary A, Wander P, Satija M, Sharma S, Girdhar S, et al. Cardiovascular risk assessment using WHO/ISH risk prediction charts in a rural area of North India. J Res Med Dent Sci. 2016;4(2):127–31.CrossRef
31.
go back to reference Garg N, Muduli SK, Kapoor A, Tewari S, Kumar S, Khanna R, et al. Comparison of different cardiovascular risk score calculators for cardiovascular risk prediction and guideline recommended statin uses. Indian Heart J. 2017;69(4):458–63.CrossRefPubMedPubMedCentral Garg N, Muduli SK, Kapoor A, Tewari S, Kumar S, Khanna R, et al. Comparison of different cardiovascular risk score calculators for cardiovascular risk prediction and guideline recommended statin uses. Indian Heart J. 2017;69(4):458–63.CrossRefPubMedPubMedCentral
32.
go back to reference Selvarajah S, Kaur G, Haniff J, Cheong KC, Hiong TG, van der Graaf Y, et al. Comparison of the Framingham Risk Score, SCORE and WHO/ISH cardiovascular risk prediction models in an Asian population. Int J Cardiol. 2014;176(1):211–8.CrossRefPubMed Selvarajah S, Kaur G, Haniff J, Cheong KC, Hiong TG, van der Graaf Y, et al. Comparison of the Framingham Risk Score, SCORE and WHO/ISH cardiovascular risk prediction models in an Asian population. Int J Cardiol. 2014;176(1):211–8.CrossRefPubMed
33.
go back to reference Leung Y, Lin S, Lee RS, Lam T, Schooling C. Framingham risk score for predicting cardiovascular disease in older adults in Hong Kong. Hong Kong Med J. 2018;24 Suppl 4:8–11.PubMed Leung Y, Lin S, Lee RS, Lam T, Schooling C. Framingham risk score for predicting cardiovascular disease in older adults in Hong Kong. Hong Kong Med J. 2018;24 Suppl 4:8–11.PubMed
34.
go back to reference Nakhaie MR, Koor BE, Salehi SO, Karimpour F. Prediction of cardiovascular disease risk using framingham risk score among office workers, Iran, 2017. Saudi J Kidney Dis Transpl. 2018;29(3):608.CrossRefPubMed Nakhaie MR, Koor BE, Salehi SO, Karimpour F. Prediction of cardiovascular disease risk using framingham risk score among office workers, Iran, 2017. Saudi J Kidney Dis Transpl. 2018;29(3):608.CrossRefPubMed
35.
go back to reference Tennakoon SU, Kumar BN, Nugegoda DB, Meyer HE. Comparison of cardiovascular risk factors between Sri Lankans living in Kandy and Oslo. BMC Public Health. 2010;10(1):1–7.CrossRef Tennakoon SU, Kumar BN, Nugegoda DB, Meyer HE. Comparison of cardiovascular risk factors between Sri Lankans living in Kandy and Oslo. BMC Public Health. 2010;10(1):1–7.CrossRef
Metadata
Title
Recalibration of Framingham risk for a local population of Sri Lanka
Authors
Sameera Upashantha Ranasinghe
E. M. D. S. Ekanayake
Laksitha Iroshan Ranasinghe
Sampath U. B. Tennakoon
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2024
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-023-17601-8

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