Background
Study context
Methods
Cambodia | Malaysia | Mongolia | |
---|---|---|---|
Date of data collection | Feb – Apr 2010 | Sep 2005 – Feb 2006 | Oct-Dec 2009 |
Response rate | |||
Questionnaire | 96.3% | 84.6% | 95% |
Physical measurements | 94.2% | 84.6% | 95% |
Biochemical measurements | 92.7% | 84.6% | 95%1
|
Sample size aged (25–64) | 5,433 | 2,572 | 4,539 |
Sample size aged (40–64 years) | 3244 | 1631 | 2234 |
Sample size aged 40–64 years with data on DM & HT & included in the current study for CVD risk assessment | 3090 | 1618 | 8451
|
Male: % | 35.0 | 42.3 | 40.5 |
Unweighted (N) | (1137) | (690) | (905) |
Weighted (%) | 47.4 | 51.3 | 50.3 |
Age in years: mean (SD) | |||
Unweighted | 49.7 (0.15) | 50.3 (0.17) | 49.2 (0.14) |
Weighted | 50.7 (0.12) | 49.2 (0.71) | 48.9(0.16) |
Measurement of Blood pressure (measured 3 times in sitting position) | NISSEI Digital Blood Pressure Monitor (Model DS-500) | Stethoscope & mercury-stand sphygmomanometer | Omron Model 5 Automatic Blood Pressure Monitor |
Measurement of fasting Blood/plasma sugar and cholesterol | Whole capillary blood taken from fingertips; dry chemical reagent strips & Accutrend GCT instruments | 5 ml venous blood; plasma glucose: enzymatic assay kit (GlucoseFlex® reagent cartridge); total cholesterol: enzymatic colorimetric tests | Same as in Cambodia |
Calculating total CVD risk using WHO/ISH risk prediction charts
Statistical methods
Results
Distribution of individual risk factors used in total CVD risk assessment
Men | Women | Total | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Age | 40-49 | 50-59 | 60-64 | 40-64 | 40-49 | 50-59 | 60-64 | 40-64 | 40-49 | 50-59 | 60-64 | 40-64 | |
Cambodia
|
HT
| 14.3 (10.9-17.6) | 18.8 (14.5-23.0) | 26.2 (19.1-33.2) |
17.2 (14.7-19.7)
| 9.8 (7.8-11.8) | 15.0 (12.2-17.8) | 20.4 (14.9-25.9) |
12.9 (11.2-14.6)
| 12.0 (10.0-14.0) | 16.7 (14.1-19.2) | 23.4 (18.8-28.1) |
15.0 (13.4-16.6)
|
DM
| 3.1 (1.7-4.6) | 3.6 (1.7-5.5) | 8.0 (3.6-12.5) |
3.9 (2.6-5.2)
| 3.9 (2.6-5.3) | 6.9 (4.7-9.1) | 10.7 (6.5-14.9) |
5.7 (4.5-7.1)
| 3.5 (2.5-4.5) | 5.5 (4.0-7.0) | 9.3 (6.2-12.4) |
4.9 (3.9-5.8)
| |
HC
| 2.9 (1.4-4.3) | 3.6 (1.6-5.6) | 4.6 (1.2-8.0) |
3.3 (2.0-4.6)
| 2.8 (1.6-4.1) | 9.2 (6.9-11.5) | 6.1 (2.7-9.4) |
5.6 (4.4-6.8)
| 2.8 (1.9-3.8) | 6.8 (5.1-8.0) | 5.3 (2.7-7.9) |
4.5 (3.5-5.5)
| |
Smoking
| 57.6 (53.0-2.2) | 60.5 (55.5-65.4) | 59.5 (51.3-67.7) |
58.8 (55.7-61.8)
| 6.2 (4.2-.1) | 7.6 (5.3-10.0) | 7.4 (3.6-11.2) |
6.9 (5.1-8.6)
| 31.6 (28.5-34.7) | 31.0 (27.7-34.3) | 34.5 (29.7-39.2) |
31.7 (29.6-33.9)
| |
Malaysia
|
HT
| 24.1 (17.3-30.9) | 35.7 (29.0-42.3) | 44.7 (27.6-61.8) |
30.3 (24.6-36.0)
| 22.5 (17.4-7.7) | 31.4 (20.7-42.1) | 47.4 (33.7-61.1) |
27.7 (22.4-33.0)
| 23.3 (18.3-28.3) | 33.6 (26.8-40.4) | 45.9 (35.1-56.7) |
29.0 (24.1-34.0)
|
DM
| 10.9 (5.9-16.0) | 15.1 (10.0-20.3) | 21.8 (8.1-35.6) |
13.5 (9.8-17.2)
| 13.5 (9.4-17.6) | 23.1 (16.0-30.1) | 23.5 (14.3-32.6) |
17.7 (13.8-21.7
| 12.2 (8.7-15.7) | 18.9 (14.2-23.6) | 22.6 (13.4-31.7) |
15.6 (12.6-18.5)
| |
HC
| 21.2 (16.7-25.6) | 26.6 (19.8-33.4) | 25.4 (15.3-35.5) |
23.6 (19.9-27.3)
| 20.9 (14.7-7.1) | 31.3 (25.0-37.6) | 30.0 (19.2-40.7) |
25.4 (21.8-29.0)
| 21.0 (16.8-25.2) | 28.9 (24.1-33.6) | 27.5 (19.9-35.0) |
24.5 (21.3-27.7)
| |
Smoking
| 48.2 (41.3-55.1) | 38.2 (30.4-46.0) | 27.7 (14.3-41.1) |
42.6 (38.2-47.0)
| 3.1 (1.1-5.1) | 2.6 (0.9-4.2) | 10.0 (2.5-17.6) |
3.5 (1.8-5.1)
| 25.8 (22.0-29.7) | 21.3 (16.3-26.3) | 19.7 (12.3-27.1) |
23.6 (21.1-26.2)
| |
Mongolia
|
HT
| 43.3 (37.6-49.0) | 57.3 (49.8-64.7) | 69.1 (60.4-77.8) |
50.1 (46.2-54.0)
| 33.3 (29.8-6.9) | 48.5 (42.5-54.6) | 45.6 (29.3-61.9) |
39.0 (35.0-43.1)
| 38.3 (34.8-41.8) | 53.1 (48.6-57.6) | 58.2 (47.7-68.7) |
44.6 (41.8-47.4)
|
DM
| 10.5 (3.0-18.0) | 11.5 (4.0-18.9) | 7.9 (0.0-16.2) |
10.6 (5.0-16.1)
| 4.1 (1.1-7.2) | 4.8 (1.6-8.0) | 2.9 (0,0-8,8) |
4.2 (1.9-6.5)
| 7.3 (3.4-11.2) | 8.1 (4.1-12.1) | 5.3 (0.3-10.4) |
7.4 (4.6-10.2)
| |
HC
| 9.3 (3.4-15.3) | 26.2 (14.1-38.3) | 1.5 (0.0-4.6) |
14.1 (9.1-19.0)
| 12.7 (8.5-16.8) | 13.5 (8.5-18.5) | 2.8 (0.0-6.9) |
12.2 (9.2-15.1)
| 11.0 (7.2-14.7) | 19.8 (13.5-26.1) | 2.1 (0.0-4.7) |
13.1 (10.3-16.0)
| |
Smoking
| 59.9 (53.3-66.6) | 48.2 (42.0-54.4) | 42.7 (31.4-54.0) |
54.6 (49.7-59.6)
| 10.0 (6.6-13.4) | 6.6 (3.2-10.1) | 4.1 (0.3-7.8) |
8.5 (5.7-11.3)
| 34.7 (31.0-38.4) | 28.0 (23.8-32.2) | 24.4 (17.4-31.4) |
31.7 (29.4-34.0)
|
Population distribution of ‘total’ CVD risk using WHO/ISH risk prediction charts alone
Men | Women | Total | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Age | 40-49 | 50-59 | 60-64 | 40-64 | 40-49 | 50-59 | 60-64 | 40-64 | 40-49 | 50-59 | 60-64 | 40-64 | |
Cambodia
| Low risk | 99.2 (98.4-99.9) | 95.8 (93.5-98.1) | 78.7 (71.9-85.4) |
95.6 (94.3-96.8)
| 99.8 (99.5-100.0) | 97.7 (96.5-98.9) | 94.0 (90.4-97.6) |
98.4 (97.8-99.0)
| 99.5 (99.1-99.9) | 96.8 (95.6-98.0) | 85.9 (82.2-89.7) |
97.0 (96.4-97.7)
|
Moderate risk | 0.2 (0.0-0.5) | 2.5 (0.7-4.3) | 14.5 (8.7-20.3) |
2.7 (1.7-3.7)
| 0.1 (0.0-1.7) | 1.2 (0.3-2.2) | 2.6 (1.4-5.0) |
0.8 (0.3-1.2)
| 0.1 (0.0-0.3) | 1.8 (0.9-2.7) | 8.8 (5.7-12.0) |
1.7 (1.2-2.2)
| |
High risk | 0.6 (0.0-1.3) | 1.7 (0.1-3.3) | 6.8 (2.7-11.0) |
1.7 (0.9-2.5)
| 0.2 (0.0-0.5) | 1.2 (0.3-1.9) | 3.4 (0.6-6.3) |
0.9 (0.4-1.3)
| 0.4 (0.1-0.8) | 1.4 (0.5-2.2) | 5.2 (2.7-7.8) |
1.3 (0.8-1.7)
| |
Malaysia
| Low risk | 97.3 (95.6-99.0) | 92.6 (89.4-95.8) | 76.5 (65.3-87.6) |
93.7 (91.8-95.6)
| 98.0 (96.8-99.2) | 96.3 (94.2-98.4) | 79.2 (70.5-87.9) |
95.9 (94.4-97.4)
| 97.6 (96.6-98.7) | 94.4 (92.6-96.2) | 77.8 (70.9-84.6) |
94.4 (91.0 -7.8)
|
Moderate risk | 1.2 (0.3-2.2) | 4.4 (1.4-7.3) | 15.4 (7.4-23.5) |
3.7 (2.3-5.1)
| 0.8 (0.0-1.5) | 2.6 (0.9-4.4) | 12.0 (3.9-20.2) |
2.3 (1.2-3.5)
| 1.0 (0.4-1.6) | 3.5 (2.1-5.0) | 13.9 (8.5-19.3) |
3.3 (0.7-5.8)
| |
High risk | 1.5 (0.0-2.9) | 3.0 (1.1-4.9) | 8.1 (1.6-14.6) |
2.6 (1.4-3.9)
| 1.2 (0.2-2.3) | 1.1 (0.0-2.3) | 8.7 (3.9-13.6) |
1.8 (0.9-2.6)
| 1.4 (0.5-2.2) | 2.1 (0.9-3.3) | 8.4 (4.3-12.4) |
2.3 (0.7-5.4)
| |
Mongolia
| Low risk | 94.7 (91.1-98.3) | 84.6 (77.4-91.8) | 50.0 (34.8-65.2) |
87.8 (84.4-91.3)
| 94.1 (90.5-97.7) | 88.2 (82.4-94.1) | 80.7 (65.6-95.8) |
91.2 (87.6-94.7)
| 94.4 (92.0-96.8) | 86.4 (82.0-90.9) | 65.5 (52.2-78.8) |
89.6 (86.8-92.2)
|
Moderate risk | 1.7 (0.0-3.9) | 7.4 (1.8-13.0) | 19.4 (3.0-35.9) |
5.0 (2.3-7.7)
| 1.9 (0.1-3.8) | 8.3 (2.6-14.1) | 3.0 (0.0-8.8) |
4.0 (1.8-6.2)
| 1.8 (0.4-3.2) | 7.9 (3.9-11.8) | 11.1 (1.9-20.4) |
4.5 (2.9-6.1)
| |
High risk | 3.6 (0.7-6.5) | 7.9 (2.2-13.7) | 30.5 (12.6-8.5) |
7.2 (4.3-0.1)
| 4.0 (1.2-6.8) | 3.4 (0.9-5.9) | 16.3 (4.6-28.0) |
4.8 (2.7-7.0)
| 3.8 (1.8-5.7) | 5.7 (2.6-8.7) | 23.3 (11.9-34.8) |
6.0 (4.0-8.0)
|
Estimation of population total CVD risk distribution after inclusion of individuals with high levels of other risk factors (per WHO guidelines for chart use in individuals)
Inclusion criteria | Cambodia (N = 3090) | Malaysia (N = 1618) | Mongolia (N = 845) | ||||||
---|---|---|---|---|---|---|---|---|---|
Low | Mod | High | Low | Mod | High | Low | Mod | High | |
Simple application of chart | 97.7 (96.4-97.7) | 1.7 (1.1-2.2) | 1.3 (0.8-1.7) | 94.4 (91.0 -97.8) | 3.3 (0.7-5.8) | 2.3 (−0.7-5.4) | 89.6 (86.8-92.2) | 4.5 (2.9-6.1) | 6.0 (4.0-8.0) |
Chart + BP 160/100 | 94.3 (93.4-95.3) | 0.8 (0.4-1.2) | 4.8 (3.8-5.8) | 90.3 (85.9 – 94.7) | 2.0 (0.2 – 3.9) | 7.7 (3.9 – 11.4) | 79.2 (74.7-83.8) | 0.2 (0.0-0.6) | 20.5 (10.0-25.1) |
Chart + BP 60/100 BP + Cholesterol > =8 mmol/l | na | na | na | 89.0 (83.4-94.6) | 1.4 (0.6-2.5) | 9.6 (4.7-14.5) | na | na | na |
Chart + BP 60/100 BP + Cholesterol > =8 mmol/l + on HT Medication | 88.8 (87.4 – 90.2) | 0.8 (4.1 – 1.1) | 10.4 (0.9-11.9) | 78.5 (61.5 – 95.6) | 0.7 (0.3 – 1.0) | 20.8 (3.7 – 37.9) | 66.4 (60.7-72.1) | 0.2 (0.0 – 0.6) | 33.3 (27.6-39.0) |
Proportion of people in the low and moderate risk categories with additional risk factors that may increase the risk estimated by the charts
Cambodia (N = 3090) | Malaysia (N = 1618) | Mongolia (N = 764) | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Low (n = 3003) | Mod (n = 48) | High (n = 38) | Total | Low (n = 1484) | Mod (n = 60) | High (n = 60) | Total | Low (n = 674) | Mod (n = 36) | High (n = 54) | Total | |
Obesity
| 2.3 (1.8-3.0) | 11.8 (4.7-26.2) | 0.9 (0.1-6.8) |
2.4 (1.9-3.1)
| 15.3 (12.3-8.8) | 18.9 (14.6-4.2) | 34.0 (28.2-0.4) |
15.8 (13.0-9.1)
| 23.9 (19.7-8.7) | 37.1 (21.8-55.3) | 42.0 (27.3-58.3) |
25.7 (21.6-30.3)
|
Low physical activity
| 9.7 (8.4-11.2) | 12.6 (5.5-26.3) | 6.1 (1.5-21.3) |
9.7 (8.4-11.2)
| 27.4 (23.9-1.2) | 28.3 (18.3-1.2) | 14.3 (5.1-34.0) |
27.2 (23.7-1.0)
| 8.3 (5.4-12.7) | 9.9 (2.5-32.2) | 16.3 (6.4-35.8) |
8.9 (5.8-13.5)
|
High pulse rate
| 15.3 (13.9-16.9) | 16.6 (8.4-30.0) | 30.1 (16.0-49.2) |
15.5 (14.1-17.1)
| 6.6 (4.9-8.7) | 12.7 (7.9-19.7) | 18.5 (10.0-31.6) |
7.1 (5.4-9.1)
| 14.1 (11.0-7.8) | 6.0 (1.4-21.9) | 20.4 (11.2-34.2) |
14.1 (11.3-17.5)
|
Currently on HT medication
| 6.2 (5.2-7.5) | 15.3 (7.5-28.7) | 43.7 (28.3-60.4) |
6.9 (5.8-8.2)
| 12.3 (3.6-34.8) | 37.7 (20.8-58.3) | 31.9 (19.8-47.0) |
13.6 (4.3-35.4)
| 18.8 (14.6-3.8) | 52.1 (33.2-70.5) | 68.7 (50.3-82.6) |
23.6 (18.9-29.1)
|
High triglycerides
| na | na | na | na | 27.5 (22.0-33.4) | 52.0 (45.3-58.5) | 40.9 (34.0-48.3) |
28.5 (23.5-34.1)
| 18.8 (13.3-5.9) | 23.1 (10.6-43.1) | 7.0 (2.7-17.2) |
18.2 (13.2-24.6)
|
Low HDL
| na | na | na | na | 27.3 (24.0-30.9) | 25.8 (14.1-42.3) | 36.2 (29.0-44.1) |
27.4 (24.1-31.1)
| 20.7 (14.9-7.9) | 38.0 (21.0-58.6) | 32.1 (19.1-48.4) |
22.2 (16.2-29.8)
|