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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2018  |  Volume : 29  |  Issue : 3  |  Page : 608-614
Prediction of cardiovascular disease risk using framingham risk score among office workers, Iran, 2017

1 Department of Nutrition, Arak University of Medical Sciences, Arak, Iran
2 Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
3 Department of Nutrition, Yasuj University of Medical Sciences, Yasuj, Iran

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Date of Submission30-May-2017
Date of Acceptance01-Jul-2017
Date of Web Publication28-Jun-2018


Cardiovascular diseases (CVDs) are leading cause of morbidity and mortality and early identification of risk factors can help reduce mortality from them. The aim of this study was to determine the risk of CVD based on the Framingham Risk Score (FRS) among office workers, Yasuj City, Southwestern Iran. In this descriptive study, 180 workers aged 30-74 years old free of cardiovascular disease were recruited by single-stage stratified cluster sampling from the office of Yasuj City. Analysis showed that 163 workers (90.5%) were at low risk, 12 people (6.6%) at moderate risk, and five people (2.9%) at high 10-year risk of CVD. Mean of FRS and 10-year prediction of CVD risk was significantly higher among male workers than females. Subjects with normal body mass index than overweight and obese people had only significantly lower FRS (P <0.001), but 10-year risk of CVD did not differ among groups. Participants with Master of Science and above educational degree and subjects with normal waist-to-hip ratio had only significantly lower 10-year risk of CVD (P < 0.001). Nonsmokers, whose with systolic blood pressure <140 mm Hg, total cholesterol <240 mg/dL, normal total cholesterol/high-density lipoprotein-cholesterol (HDL-C), and abnormal HDL-C had significantly lower both FRS and 10-year CVD risk (P <0.01). This population-based study will health care policy makers develop targeted strategies to develop individual and community-based health care promotion programs.

How to cite this article:
Nakhaie MR, Koor BE, Salehi SO, Karimpour F. Prediction of cardiovascular disease risk using framingham risk score among office workers, Iran, 2017. Saudi J Kidney Dis Transpl 2018;29:608-14

How to cite this URL:
Nakhaie MR, Koor BE, Salehi SO, Karimpour F. Prediction of cardiovascular disease risk using framingham risk score among office workers, Iran, 2017. Saudi J Kidney Dis Transpl [serial online] 2018 [cited 2022 May 20];29:608-14. Available from: https://www.sjkdt.org/text.asp?2018/29/3/608/235179

   Introduction Top

Cardiovascular diseases (CVDs) are most common noncommunicable chronic disease[1] and the leading cause of death in the world, Middle East region, and Iran. It is predicted that death from CVDs reaches 25 million in 2020[2],[3] and will rise to more than 23.6 million in 2030.[4] Like other noncommunicable diseases, these disorders start with simple atherosclerotic process such as inflammation that leads to accumulation of atherosclerotic plaques. These plaque subsequently ruptures and thus leads to thrombosis or blockage of the vessels.[4] Treatment of these diseases forces many costs on health-care systems.[5] Since prevention is always before treatment, identifying risk factors of atherosclerosis as starter of most cardiovascular disease is important. According to studies, some of them are nonmodifiable risk factors such as age, sex, and race, and others include smoking status, blood pressure, obesity, blood lipid profiles, and diabetes that are somewhat modifiable. These risk factors are not separate, do not effect independently, and have even synergistic effect with each other and therefore have to assess their total impact. Many criteria, indicators, and tools have been developed to predict the incidence of CVD. These tools can help identify people at high risk and thus enhance the awareness of people, and thus, they can improve their lifestyle which can reduce even morbidity and mortality.[6] Perhaps, one of the oldest and yet simplest and most functional of them is now Framingham Risk Score (FRS). This tool recommended by the National Cholesterol Education Program (Adult Treatment Panel III) and validated and applied in many studies.[7],[8],[9] This algorithm can predict 10-year CVD risk in populations.[10] In this scoring be used history, clinical and laboratory measurements, thus used as the gold standard[11] and was validated in multi-ethnic populations studies.[12] The aim of this study was to assess and predict of CVD risks using FRS among office workers, Yasuj City, Iran.

   Methods Top

In this cross-sectional study, 180 workers aged 30–74 years old free of CVD were recruited by single-stage stratified cluster sampling from the office of Yasuj City. This study was approved by the Ethical Committee of Yasuj University of Medical Science (by ethical code: IR.YUMS.REC.1395.88). After obtaining informed written consent, subjects' weight was measured without shoes and with minimal clothing by health expert using scale with an accuracy of 1 kg. Scales were balanced by 5 kg standard weights at the beginning and end of work days. Subjects' standing height was measured using a calibrated gauge with 5-cm accuracy. Body mass index (BMI) is widely accepted definition of obesity that is calculated as weight (kg) divided by squared height (m2). Blood pressure was measured on the left arm of the seated participants after a 5-min rest by standard protocol using calibrated instruments as has been described previously.[13] Diabetes onset and smoking status were ascertained by the use of insulin or oral hypoglycemic medication self-report. FRS was calculated based on D'Agostino et al method which consists of sex, age, blood pressure, smoking, onset of diabetes, total cholesterol (TC), and high-density lipoprotein-cholesterol (HDL-C). Based on acquired points of each variables listed above, overall FRS was between 0 and 25, and based on given FRS score in both sexes, cardiovascular disease risk was calculated from <1% to 30%. Rate of <10% indicates low-risk, 10%–20% indicates moderate-risk, and >20%, indicates high-risk 10-year CVD.[14] In this study, cutoff point of TC/HDL-C ratio was defined as ≥5.[15] The data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 19.0 for Windows (SPSS Inc., Chicago, IL, USA). The qualitative variables were expressed as the exact amount and percentage and the quantitative variables as the mean and standard deviation. The association between qualitative variables was done with Chi-square test. Mean of independent variable was comprised by Student's t-test and ANOVA.[10] Significant associations were defined by P <0.05.

   Results Top

In this study, 124 males (68.9%) and 56 females (31.1%) were included in the study. Some sociodemographic data of subjects were presented in [Table 1]. Weight, height, age, waist-to-hip ratio (WHR), blood pressure, and occupation duration of male subjects were significantly higher than females, but hip circumference and BMI of females were higher significant. Lipid profiles (TC and HDL-C) were not different significantly among both sexes.
Table 1: Some sociodemographic data of subjects

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According to [Table 2], age score and smoking score of men were significantly higher than women, but cholesterol score, HDL score, and blood pressure score were not different significantly among both sexes. FRS and 10-year CVD were higher among men compared with women significantly.
Table 2: Components of Framingham Risk Score and 10-year cardiovascular disease risk data of subjects.

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Among all subjects, 163 participants (90.5%) had low 10-year CVD risk, 12 people (6.6%) had moderate risk, and five subjects (2.6%) were anticipated that at high risk.

Any of the participants was not underweight. According to ANOVA test, subjects with normal weight had significantly lower FRS compared to those overweight and obese people (F = 7.07, P = 0.001), but 10-year CVD risk did not differ among people with different BMI groups. Subjects with different systolic blood pressure (SBP) groups had significant FRS and 10-year CVD risk (F = 9.24, P = 0.0001 and F = 10.7, P = 0.0001 respectively), on that people with SBP <130 mm Hg had significantly lower FRS and 10-year CVD risk than people with SBP >130 mm Hg. Subjects with normal and abnormal WHR had no different FRS, but if the subjects normal WHR had higher 10-year CVD risk (t = 3.24, P = 0.001). Mean of FRS and 10-year CVD risk was not significantly different among people with different educational degrees, but participants with Master of Science and above educational degree had significantly lower 10-year CVD risk (t = 5.07, P = 0.007) [Table 3]. Smokers had significantly higher FRS and 10-year CVD risk than nonsmokers (t = 4. 3, P = 0.0001, t = 3.07, P = 0.0001, respectively). Unexpectedly, whose with abnormal HDL had significantly lower FRS and 10-year CVD risk than normal group (t = 2. 3, P = 0.033, t= 3.4, P = 0.001, respectively), but as expected, people with cholesterol concentration >240 mg/dL had significantly higher FRS and 10-year CVD risk than normal group (t = 4. 5, P = 0.0001, t = 3.3, P = 0.01, respectively). People with abnormal TC/HDL-C than normal group had significantly higher FRS and 10-year CVD risk (t = 3.1, P = 0.002, t = 2.4, P = 0.015, respectively).
Table 3: Mean difference of Framingham Risk Score and 10-year cardiovascular disease risk data of subjects based some characteristics.

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   Discussion Top

Based on our finding, 90.5% of subjects were at low anticipated 10-year CVD risk, 6.6% had moderate risk, and 2.6% of them were at high risk. Sedentary lifestyle is one of major risk factors of CVD.[2] Other studies showed that 5%–9% predicted high risks of CVD that were closed to our results.[16],[17] In other studies, even 30% of the population showed at predicted high 10-year CVD risk.[12],[14] This different predicted 10-year CVD risk can attributed for risk factors such rice and other sociodemo-graphic determinants.

In our study, mean of FRS and 10-year CVD risk was significantly higher among female than male; on the other hand, we anticipate that women will suffer less than men from CVD over the next 10 years. Other studies showed similar to the present study.[14] Child-bearing age women (similar to women in our study) than men were diagnosed CVD, 10-15years later due to the protective effects of estrogen against CVD.[18]

In this study, workers with normal BMI had significantly lower FRS compared to those overweight and obese people, but 10-year CVD risk did not differ among BMI groups. Unexpectedly, participants with normal WHR had significantly higher 10-year CVD risk than abnormal WHR group.

Our study well demonstrated association between education and CVD risk. Workers with Master of Science and above education level had significantly lowest FRS and 10-year CVD risk than lower degree, and this perhaps suggests that overall education has a critical role for improving health outcomes. Higher education level helps access to social services, income, social status, and increase public awareness on healthy food choices and ultimately improve the living standards as key social determinant of health.[7] It affects the habits and behaviors related to health, such as quality of food, smoking, and level of physical activity. In developed countries and perhaps in developing countries, certain risk factors such as smoking, obesity, and physical inactivity and certain diseases such as CVD, hypertension, and hypercholesterolemia are more common in lower socioeconomic classes.[19],[20]

In this study, smokers have significantly higher FRS and 10-year CVD risk than nonsmokers, which means that smoking increases predicted 10-year onset of CVD. Considering that in some studies, smoking was reported by 30% of participants[10] and only 11% of our population reported smoking; may be some of the participants did not report smoking due to social and cultural considerations. It was known that smoking cessation can significantly reduce the inflammatory cytokines and acute and chronic risk of cardiovascular disease.[21],[22]

In this study, association of total cholesterol with FRS and 10-year CVD risk was expectedly, but association of HDL-C was not expectedly. On the other hand, workers with abnormal HDL-C had lower FRS and 10-year CVD risk than normal group. However, TC/ HDL-C ratio showed expectedly association with FRS and 10-year CVD risk. Because of better expectedly association of TC/HDL-C ratio than HDL-C with FRS and 10-year CVD risk, we can propose the modification of FRS equation. Decreased HDL-C and increased total cholesterol cause fat layer deposition in the vessel, disturbances in blood flow even blockage of blood flow and increased blood pressure, especially in the coronary heart vessels, induces macrophage activity and synthesis of inflammatory mediators and thus also accelerating CVD.[21],[22]

   Limitation and Strength Top

This was a cross-sectional study, and in this study, we cannot any causal correlations, thus conducting of cohort study with more and more populations for identification of cardiovascular events and even death is necessary.

Conflict of interest: None declared.

   References Top

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Correspondence Address:
Behrooz Ebrahimzadeh Koor
Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1319-2442.235179

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