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Comparison of WHO laboratory-based and non-laboratory-based CVD risk charts among hypertensive adults attending primary healthcare centers in West Africa sub-region
Journal
PLOS One
ISSN
1932-6203
Date Issued
2025-06-09
Author(s)
Kojo Awotwi Hutton-Mensah
Olayinka Rasheed Ibrahim
Adaku Nwankwo
George Bediako Nketiah
Funmi Temidayo Adeniyi
Abukari Yakubu Natogmah
James Ayodele Ogunmodede
Dike Ojji
Olumide Adesola
Biodun Sulyman Alabi
Olugbenga Ayodeji Mokuolu
Daniel Sarpong
Editor(s)
Ryan G Wagner
DOI
https://doi.org/10.1371/journal.pone.0317640
Abstract
Background
The World Health Organization (WHO) non-laboratory cardiovascular disease (CVD) risk chart is sub-region-specific and is advocated in resource-constrained settings. However, the extent of agreement with laboratory-based assessment among hypertensive adults attending primary health centers (PHCs) in the West Africa sub-region remains unknown. This study compared 10-year CVD risk among adults with hypertension attending PHCs in Ghana and Nigeria.
Materials and methods
This cross-sectional study recruited 319 adults with hypertension at PHCs in Ghana and Nigeria. All participants had their blood pressure, anthropometrics, fasting blood sugar, and fasting cholesterol measured following standard procedures. WHO laboratory and non-laboratory CVD risks were assessed and compared using Kappa statistics, correlation, and Bland-Altman Plot,
Results
The median (interquartile range) for laboratory-based and non-laboratory-based CVD risk scores were comparable [7.0 (4.0 11.0) vs. 7.0 (4.0 to 11.0), p = 0.914]. Of the 319 participants, laboratory-based assessment classified 214 (67.1%) as low risk, while 210 (65.8%) were classified as low risk using the non-laboratory method. Eleven (3.4%) and 14 (4.4%) participants were classified as high-risk using laboratory- and non-laboratory-based methods, respectively. Overall, there was a very good positive correlation between the CVD risk assessment methods (r = 0.948, p<0.001). For all participants combined, there was substantial agreement (Kappa statistics), with K = 0.766. Bland-Altman showed a mean bias of 0.15 (SD = 1.74) in favor of non-laboratory-based assessment of CVD with an upper limit of 3.57 and a lower limit of –3.26.
Conclusion
There was substantial agreement between laboratory- and non-laboratory-based WHO CVD risk charts in this study. In low-resource settings, such as Ghana and Nigeria, the WHO non-laboratory CVD risk prediction model offers a huge opportunity for primary CVD prevention in adults with hypertension.
The World Health Organization (WHO) non-laboratory cardiovascular disease (CVD) risk chart is sub-region-specific and is advocated in resource-constrained settings. However, the extent of agreement with laboratory-based assessment among hypertensive adults attending primary health centers (PHCs) in the West Africa sub-region remains unknown. This study compared 10-year CVD risk among adults with hypertension attending PHCs in Ghana and Nigeria.
Materials and methods
This cross-sectional study recruited 319 adults with hypertension at PHCs in Ghana and Nigeria. All participants had their blood pressure, anthropometrics, fasting blood sugar, and fasting cholesterol measured following standard procedures. WHO laboratory and non-laboratory CVD risks were assessed and compared using Kappa statistics, correlation, and Bland-Altman Plot,
Results
The median (interquartile range) for laboratory-based and non-laboratory-based CVD risk scores were comparable [7.0 (4.0 11.0) vs. 7.0 (4.0 to 11.0), p = 0.914]. Of the 319 participants, laboratory-based assessment classified 214 (67.1%) as low risk, while 210 (65.8%) were classified as low risk using the non-laboratory method. Eleven (3.4%) and 14 (4.4%) participants were classified as high-risk using laboratory- and non-laboratory-based methods, respectively. Overall, there was a very good positive correlation between the CVD risk assessment methods (r = 0.948, p<0.001). For all participants combined, there was substantial agreement (Kappa statistics), with K = 0.766. Bland-Altman showed a mean bias of 0.15 (SD = 1.74) in favor of non-laboratory-based assessment of CVD with an upper limit of 3.57 and a lower limit of –3.26.
Conclusion
There was substantial agreement between laboratory- and non-laboratory-based WHO CVD risk charts in this study. In low-resource settings, such as Ghana and Nigeria, the WHO non-laboratory CVD risk prediction model offers a huge opportunity for primary CVD prevention in adults with hypertension.
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