Laboratory-based versus non-laboratory-based method for assessment of cardiovascular disease risk: the NHANES I Follow-up Study cohort
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Background Around 80% of all cardiovascular deaths occur in developing countries. Assessment of those patients at high risk is an important strategy for prevention. Since developing countries have limited resources for prevention strategies that require laboratory testing, we assessed if a risk prediction method that did not require any laboratory tests could be as accurate as one requiring laboratory information.Methods The National Health and Nutrition Examination Survey (NHANES) was a prospective cohort study of 14 407 US participants aged between 25-74 years at the time they were first examined (between 1971 and 1975). Our follow-up study population included participants with complete information on these surveys who did not report a history of cardiovascular disease (myocardial infarction, heart failure, stroke, angina) or cancer, yielding an analysis dataset N=6186. We compared how well either method could predict first-time fatal and non-fatal cardiovascular disease events in this cohort. For the laboratory-based model, which required blood testing, we used standard risk factors to assess risk of cardiovascular disease: age, systolic blood pressure, smoking status, total cholesterol, reported diabetes status, and current treatment for hypertension. For the non-laboratory-based model, we substituted body-mass index for cholesterol.Findings In the cohort of 6186, there were 1529 first-time cardiovascular events and 578 (38%) deaths due to cardiovascular disease over 21 years. In women, the laboratory-based model was useful for predicting events, with a c statistic of 0.829. The c statistic of the non-laboratory-based model was 0.831. In men, the results were similar (0.784 for the laboratory-based model and 0.783 for the non-laboratory-based model). Results were similar between the laboratory-based and non-laboratory-based models in both men and women when restricted to fatal events only.Interpretation A method that uses non-laboratory-based risk factors predicted cardiovascular events as accurately as one that relied on laboratory-based values. This approach could simplify risk assessment in situations where laboratory testing is inconvenient or unavailable.
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Current evidence shows that CVD screening can be shifted effectively from formally trained health professionals to community health workers using a validated, low-cost, nonlaboratory-based screening tool.
“Current evidence shows that CVD screening can be shifted effectively from formally trained health professionals to community health workers (CHWs) using a validated, low‐cost, nonlaboratory‐based screening tool.8, 9”
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- Authors
- Gaziano, T. A., Young, C. R., Fitzmaurice, G., Atwood, S., & Gaziano, J. M.
- Affiliations
- Brigham and Women's Hospital (US)
- Harvard University (US)
- McLean Hospital (US)
- Corresponding author
- Gaziano, Thomas A
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2008-03
- Volume
- 371
- Issue
- 9616
- Pages
- 923-931
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- PMC
- PMC2864150
- OpenAlex
- W2114678398
- Cited by
- 366
- References
- 34
- Citations by year
- 2026: 8 · 2025: 15 · 2024: 18 · 2023: 6 · 2022: 14 · 2021: 23 · 2020: 27 · 2019: 17 · 2018: 17 · 2017: 21 · 2016: 13 · 2015: 33 · 2014: 19 · 2013: 23 · 2012: 19
- FWCI
- 30.34
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Fogarty International Center (K01TW007141)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Keywords
- cardiovascular risk prediction, body mass index, total cholesterol, laboratory testing, risk assessment, cardiovascular mortality, cardiovascular events, developing countries, resource-limited settings
- MeSH terms
- Adult, Aged, Cardiovascular Diseases, Female, Follow-Up Studies, Humans, Hypertension, Male, Middle Aged, Models, Biological, Nutrition Surveys, Predictive Value of Tests, ROC Curve, Smoking, United States, Risk Assessment, Diabetes Complications
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