The Significance of the WHO/ISH Absolute Cardiovascular Risk Prediction Scores among Recent Stroke Survivors in Ghana—Insights from the PINGS2 multicenter study

TL;DR

This study examines cardiovascular risk scores in recent stroke survivors in Ghana using the WHO/ISH tool and finds that most are classified as low risk.

Contribution

The study is the first to apply the WHO/ISH risk score to stroke survivors in West Africa.

Findings

Most participants (76.3%) were classified as low cardiovascular risk.

Risk scores were associated with age, income, tobacco use, blood pressure, and HbA1c.

There was no significant difference in risk by stroke type.

Abstract

The leading cause of stroke remains atherosclerotic cardiovascular disease. The World Health Organization/International Society of Hypertension risk score represents an effort to produce a risk assessment tool for atherosclerotic cardiovascular disease that is regionally specific. No previous work has described absolute cardiovascular risk scores among recent stroke survivors in West Africa via this tool.

A cross-sectional analysis of baseline data from the multicenter, phase III randomized, open-label, clinical trial, Phone-based Intervention under Nurse Guidance II (PINGS-2), was performed. Data from 414 participants who had recently survived a stroke and met the age range compatible with the risk estimation tool were analyzed. The WHO/ISH score was calculated for each participant and categorized into low, moderate, and high/very high CVD risk scores. Demographic data, medical histories, anthropometry, vascular risk profiles, stroke types and severity indices were compared across CVD risk categories. Multivariate logistic regression was performed to further examine variables significantly associated with WHO/ISH CVD risk via univariate analysis.

The mean age of the study population was 58 years (SD = 12), with the majority being male (56.5%). Ischemic strokes (n = 263, 74.3%) were more common than hemorrhagic strokes (n = 78, 22%). Over two-thirds (76.3%) of the participants were estimated to have a low (< 10%) risk of cardiovascular disease in the next 10 years, 14.5% were estimated to have a moderate risk, and only 9.2% were stratified as high or very high risk. The absolute CVD risk score was significantly associated with age, higher income, tobacco use, systolic blood pressure and HBA1c. There was no significant difference in absolute cardiovascular risk by stroke type.

A comparatively lower proportion of Ghanaian stroke survivors were classified as high risk by the WHO/ISH risk score. This raises the question of its appropriateness as a cardiovascular risk assessment tool to drive secondary prevention among this patient population.

NCT04404166. Registered on May 27,2020 at ClinicalTrials.gov