Tehran University of Medical Sciences

Science Communicator Platform

Share By
Stepwise Approach to Screen High-Risk Individuals Using the Non-Laboratory-Based and Laboratory-Based Cvd Risk Scoring Publisher Pubmed



Fahimfar N ; Eghtesad S ; Poustchi H ; Kohansal K ; Sepanlou SG ; Ostovar A ; Esmaeilinadimi A ; Bahramali E ; Pourfarzi F ; Ghaffari S ; Nejatizadeh A ; Moradpour F ; Mousavizadeh A ; Joukar F Show All Authors
Authors
  1. Fahimfar N
  2. Eghtesad S
  3. Poustchi H
  4. Kohansal K
  5. Sepanlou SG
  6. Ostovar A
  7. Esmaeilinadimi A
  8. Bahramali E
  9. Pourfarzi F
  10. Ghaffari S
  11. Nejatizadeh A
  12. Moradpour F
  13. Mousavizadeh A
  14. Joukar F
  15. Bitaraf S
  16. Mohammadkarimi V
  17. Najafi F
  18. Hosseini SV
  19. Gohari A
  20. Khaledifar A
  21. Kheradmand M
  22. Khademvatani K
  23. Lotfi MH
  24. Ansarimoghaddam A
  25. Malekzadeh R
  26. Khalili D

Source: Journal of Public Health Published:2025


Abstract

Objective We compared non-laboratory models’ efficacy with standard laboratory-based model in identifying high-risk populations for cardiovascular disease (CVD) in resource-limited settings. Methods A national sample of 121 672 individuals aged 40–70 from the PERSIAN cohort was analyzed. Non-laboratory models, including the World Health Organization (WHO) and Iranian pooled-cohort CVD mortality models, were compared with the WHO laboratory-based model. Intra-class correlation coefficient (ICC) and concordance correlation coefficient (CCC) were utilized. Sensitivity and specificity of non-laboratory models were evaluated against the laboratory-based one at various risk thresholds. The number of reduced tests in the stepwise approach was calculated considering the Iranian census. Results Both non-laboratory and laboratory-based models showed similar trends in predicting CVD risks across age groups. Strong correlations and concordance were observed in both men (ICC: 94.4%, CCC:0.893) and women (ICC: 93.8%, CCC:0.883). Utilizing a 5% risk threshold for WHO non-laboratory and 2% for the Iranian pooled-cohort CVD mortality model as the initial step achieved high sensitivity (99.6%) and moderate specificity (52%) for identifying candidates for the second-step laboratory test. This approach effectively reduced the number of tests by 16 807 982. Conclusion Non-laboratory models, in a stepwise approach, offer a promising strategy to alleviate strain on financial resources and enhance healthcare system efficiency in resource-limited countries. © The Author(s) 2025. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved.
Related Docs
View other Related Docs
1. Comparison of Laboratory-Based and Non-Laboratory-Based Who Cardiovascular Disease Risk Charts: A Population-Based Study, Journal of Translational Medicine (2022)
2. Validity of the Models Predicting 10-Year Risk of Cardiovascular Diseases in Asia: A Systematic Review and Prediction Model Metaanalysis, PLoS ONE (2023)
3. Prediction of Cardiovascular Disease Mortality in a Middle Eastern Country: Performance of the Globorisk and Score Functions in Four Population-Based Cohort Studies of Iran, International Journal of Health Policy and Management (2022)
Experts (# of related papers)
View all Related Experts
Hossein Poustchi (6)
Sadaf Ghajarieh Sepanlou (6)
Other Related Docs
4. An Office-Based Cardiovascular Prediction Model Developed and Validated in Cohort Studies of a Middle-Income Country, Journal of Clinical Epidemiology (2022)
5. Validation and Clinical Usefulness of the Score2 Cardiovascular Risk Prediction Algorithms in an Iranian Population, Journal of Diabetes and Metabolic Disorders (2025)
6. Performance of the Revised World Health Organization Cardiovascular Disease Risk Prediction Models for the Middle East and North Africa: A Validation Study in the Tehran Lipid and Glucose Study, Journal of Clinical Epidemiology (2025)
7. Laboratory-Based and Office-Based Risk Scores and Charts to Predict 10-Year Risk of Cardiovascular Disease in 182 Countries: A Pooled Analysis of Prospective Cohorts and Health Surveys, The Lancet Diabetes and Endocrinology (2017)
8. First Population-Based Study on Non-Communicable Diseases and Risk Factors in Northeastern Iran: Sabzevar Cohort Profile, BMJ Open (2026)
9. Comparison of Risk Assessment Tools for Cardiovascular Diseases: Results of an Iranian Cohort Study, Public Health (2021)
10. Diagnostic Testing for Hypertension, Diabetes, and Hypercholesterolaemia in Low-Income and Middle-Income Countries: A Cross-Sectional Study of Data for 994 185 Individuals From 57 Nationally Representative Surveys, The Lancet Global Health (2023)
11. Cardiovascular Mortality in a Western Asian Country: Results From the Iran Cohort Consortium, BMJ Open (2018)
12. The Trend of Risk for Cardiovascular Diseases During the Past Decade in Iran, Applying No-Lab and Lab-Based Prediction Models, Global Heart (2023)
13. Cardiovascular Disease Burden in the North Africa and Middle East Region: An Analysis of the Global Burden of Disease Study 1990–2021, BMC Cardiovascular Disorders (2024)
14. Evaluation of the Effectiveness of the Iran-Package of Essential Non-Communicable Disease (Irapen) Program in Reducing Cardiovascular Disease Risk in Pilot Areas, BMC Public Health (2025)
15. The Burden and Predisposing Factors of Non-Communicable Diseases in Mashhad University of Medical Sciences Personnel: A Prospective 15-Year Organizational Cohort Study Protocol and Baseline Assessment, BMC Public Health (2020)
16. Cardiovascular Disease Mortality and Years of Life Lost Attributable to Non-Optimal Systolic Blood Pressure and Hypertension in Northeastern Iran, Archives of Iranian Medicine (2015)
17. Social, Economic, Technological, and Environmental Factors Affecting Cardiovascular Diseases: A Systematic Review and Thematic Analysis, International Journal of Preventive Medicine (2022)
18. The Association Between Dietary Obesity-Prevention Score and Cardiovascular Risk Factors, BMC Nutrition (2025)
19. The Intrinsic Estimator Method for Control of Age, Period, Cohort, and Its Comparison With the Descriptive Classic Model, Iranian Journal of Epidemiology (2017)
20. Global, Regional, and National Incidence, Prevalence, and Years Lived With Disability for 354 Diseases and Injuries for 195 Countries and Territories, 1990-2017: A Systematic Analysis for the Global Burden of Disease Study 2017, The Lancet (2018)