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Title: Development of a cardiovascular risk score for use in low- and middle-income countries

Author
item ASLIBEKYAN, STELLA - Brown University
item CAMPOS, HANNIA - Harvard School Of Public Health
item LOUCKS, ERIC - Brown University
item LINKLETTER, CRYSTAL - Brown University
item ORDOVAS, JOSE - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item BAYLIN, ANA - University Of Michigan

Submitted to: Journal of Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/13/2011
Publication Date: 7/1/2011
Citation: Aslibekyan, S., Campos, H., Loucks, E.B., Linkletter, C.D., Ordovas, J.M., Baylin, A. 2011. Development of a cardiovascular risk score for use in low- and middle-income countries. Journal of Nutrition. 141(7):1375-1380.

Interpretive Summary: Several algorithms have been developed to predict cardiovascular risk (i.e., The Framingham Risk Score), but, for the most part, nutritional predictors are missing from those equations, despite extensive evidence linking diet and heart disease. Our objective for this study was to develop and validate a novel risk score in a case-control study of heart attack (myocardial infarction - MI) conducted in Costa Rica during 1994-2004. After restricting the data set to healthy participants (n = 1678) we modeled associations of lifestyle factors (unhealthy diet, decreased physical activity, smoking, waist:hip ratio, low or high alcohol intake, and low socioeconomic status) with risk for MI and developed a new risk score. The score was subsequently validated in participants with a history of chronic disease. Higher risk score values were associated with a significantly increased risk of MI (OR = 2.72). The new score includes a set of modifiable cardiovascular risk factors in the study population and can be used for more precise assessment of future risk and its prevention using dietary modification.

Technical Abstract: Summary measures of cardiovascular risk have long been used in public health, but few include nutritional predictors despite extensive evidence linking diet and heart disease. Study objectives were to develop and validate a novel risk score in a case-control study of myocardial infarction (MI) conducted in Costa Rica during 1994-2004. After restricting the data set to healthy participants (n = 1678), conditional logistic regression analyses modeled associations of lifestyle factors (unhealthy diet, decreased physical activity, smoking, waist:hip ratio, low or high alcohol intake, and low socioeconomic status) with risk for MI. Using the estimated coefficients as weights for each component, a regression model was fit to assess score performance. The score was subsequently validated in participants with a history of chronic disease. Higher risk score values were associated with a significantly increased risk of MI [OR = 2.72 (95% CI = 2.28-3.24)]. The findings were replicated in a model (n = 1392) that included the best covariate measures available in the study [OR = 2.71 (95% CI = 2.26-3.26)]. Performance of the score in different subsets of the study population showed c-statistics ranging from 0.63 to 0.67. The new score presents a quantitative summary of modifiable cardiovascular risk factors in the study population.