Results
169 patients without previous CVDs; 130(81.1%) females, mean 65 ±6.9
years (range 47-78 years) were studied. Baseline characteristics, risk
factors, and medication use of the sample are shown in Table 1. Of the
total population, 56.2% were 65 years or older. The majority, 98.8%
were Singhalese. Risk factor distribution among the study participants
was, hypertension 66.9%, hyperlipidemia 89.9%, diabetes mellitus
46.7%, smoking 2.4%, and obesity 8.3%. Patients were on medications;
antihypertensives 65.7%, lipid-lowering medications 89.9%,
anti-diabetic medications 46.2%, and antiplatelet medications 15.5%
among the total population. Men in comparison to women were older ( 68 ±
4.79 and 64 ± 7.03 years, p <0.0001 respectively), smoked more
(12.5%, 0.0%, p <0.0001) and were less likely to be on
lipid-lowering medications (77.4%, 92.7%, p=0.019).
Table 1 Baseline
characteristics of the study population
Comparison of risk factors used in the calculation of Framingham and
WHO/ISH scores and mean FRS of men and women are shown in Table 2. There
was no significant difference in the history of diabetes mellitus, use
of anti-hypertensive medications, and measured risk factors like BMI,
SBP, TC and HDL levels between men and women. The two groups were only
different from age and smoking status. However, the mean FRS of men were
significantly higher than that of females with both BMI-based (male
28.94 ± 3.17, female 17.10 ±8,62) and cholesterol-based (male 26.47 ±
4.99, female 13.86 ± 8.25) models.
Table 2 CV-risk factors
used in risk calculations and mean Framingham risk scores by sex
Patients were categorised into low(<20% ) and
high(\(\geq\)20%) CV-risk groups on risk predictions (Table 3).
80(47.3%), 62 (36.7%), 18 (10.7%), 16 (9.5%), of the participants
were predicted high risk by FRS BMI-based, FRS cholesterol-based,
WHO/ISH without-cholesterol and WHO/ISH with-cholesterol models,
respectively. Agreement between different risk models in categorizing
patients into low and high-risk groups was studied using Cohen’s kappa
statistics (Table 3).
Table 3 10-year CV-Risk
stratification of the sample with different risk models and inter-rater
agreement
The two versions of FRS models; BMI-based and cholesterol-based were in
good agreement in stratifying patients into high and low-risk groups, κ
= 0.736, p<0.0001. Similarly, the two versions of WHO/ISH
models without-cholesterol and with-cholesterol were also in good
agreement in stratifying patients into high and low-risk groups; κ =
0.804, p<0.0001. However, the agreement between, FRS BMI-based
model and WHO/ISH without-cholesterol model in stratifying patients into
high and low-risk groups was fair; κ = 0.234, p<0.0001 and FRS
BMI-based risk estimates were higher than WHO/ISH without-cholesterol
estimates. Furthermore, the agreement between, FRS cholesterol-based
model and WHO/ISH with-cholesterol model in stratifying patients into
high and low-risk groups was also fair; κ = 0.306, p<0.0001
and FRS cholesterol-based risk estimates were higher than WHO/ISH
with-cholesterol estimates.