Atherosclerotic cardiovascular disease risk among Ghanaians: A comparison of the risk assessment tools

Francis Agyekum; Florence Koryo Akumiah; Samuel Blay Nguah; Lambert Tetteh Appiah; Khushali Ganatra; Yaw Adu-Boakye; Aba Ankomaba Folson; Harold Ayetey; Isaac Kofi Owusu

doi:10.1016/j.ajpc.2024.100670

Atherosclerotic cardiovascular disease risk among Ghanaians: A comparison of the risk assessment tools

Am J Prev Cardiol. 2024 Apr 18:18:100670. doi: 10.1016/j.ajpc.2024.100670. eCollection 2024 Jun.

Authors

Francis Agyekum^{1

2}, Florence Koryo Akumiah^{2

3}, Samuel Blay Nguah⁴, Lambert Tetteh Appiah⁵, Khushali Ganatra^{2

3}, Yaw Adu-Boakye⁵, Aba Ankomaba Folson⁶, Harold Ayetey⁷, Isaac Kofi Owusu⁵

Affiliations

¹ Department of Medicine, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana.
² Department of Medicine, Korle-Bu Teaching Hospital, Accra, Ghana.
³ National Cardiothoracic Centre, Korle-Bu Teaching Hospital, Accra, Ghana.
⁴ Department of Child Health, Kwame Nkrumah University, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
⁵ Department of Medicine, School of Medicine and Dentistry, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
⁶ Department of Medicine, University of Health and Allied Sciences, Ho, Volta Region, Ghana.
⁷ Department of Medicine, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana.

Abstract

Objectives: Risk stratification is a cornerstone for preventing atherosclerotic cardiovascular disease (ASCVD). Ghana has yet to develop a locally derived and validated ASCVD risk model. A critical first step towards this goal is assessing how the commonly available risk models perform in the Ghanaian population. This study compares the agreement and correlation between four ASCVD risk assessment models commonly used in Ghana.

Methods: The Ghana Heart Study collected data from four regions in Ghana (Ashanti, Greater Accra, Northern, and Central regions) and excluded people with a self-declared history of ASCVD. The 10-year fatal/non-fatal ASCVD risk of participants aged 40-74 was calculated using mobile-based apps for Pooled Cohort Equation (PCE), laboratory-based WHO/ISH CVD risk, laboratory-based Framingham risk (FRS), and Globorisk, categorizing them as low, intermediate, or high risk. The risk categories were compared using the Kappa statistic and Spearman correlation.

Results: A total of 615 participants were included in this analysis (median age 55 [Inter quartile range 46, 64]) years with 365 (59.3 %) females. The WHO/ISH risk score categorized 504 (82.0 %), 58 (9.4 %), and 53 (8.6 %) as low-, intermediate-, and high-risk, respectively. The PCE categorized 345 (56.1 %), 181 (29.4 %), and 89 (14.5 %) as low-, intermediate- and high-risk, respectively. The Globorisk categorized 236 (38.4 %), 273 (44.4 %), and 106 (17.2 %) as low-, intermediate-, and high-risk, respectively. Significant differences in the risk categorization by region of residence and age group were noted. There was substantial agreement between the PCE vs FRS (Kappa = 0.8, 95 % CI 0.7 - 0.8), PCE vs Globorisk (Kappa = 0.6; 95 % CI 0.6 - 0.7), and FRS vs Globorisk (Kappa = 0.6; 95 % CI 0.6 - 0.7). However, there was only fair agreement between the WHO vs Globorisk (Kappa = 0.3; 95 % CI 0.3-0.4) and moderate agreement between the WHO vs PCE and WHO vs FRS.

Conclusion: There are significant differences in the ASCVD risk prediction tools in the Ghanaian population, posing a threat to primary prevention. Therefore, there is a need for locally derived and validated tools.

Keywords: ASCVD; Atherosclerotic cardiovascular disease; Cardiovascular risk; Ghana; Risk scores.