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Predicting coronary heart disease using risk assessment charts and risk factor categories

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Cardiovascular disease is the leading cause of death and disability in Egypt. An appropriate estimation of risk is important to improve cardiovascular outcomes and ensure efficient allocation of resources used to support disease prevention. Risk prediction charts have been developed to provide clinicians with a simple tool to estimate the absolute risk of developing coronary heart disease (CHD).


To test the accuracy of the World Health Organization/International Society of Hypertension (WHO/ISH) risk prediction charts in predicting and identifying people at risk of developing CHD and to propose an alternative risk assessment instrument based on simple laboratory tests, routine examination, and reported personal and medical data.


A cross-sectional screening survey was conducted at an emergency department of a health insurance hospital in Alexandria, Egypt. A total of 350 enrolled patients were evaluated clinically. We applied the WHO/ISH risk assessment chart for the Eastern Mediterranean region to test its accuracy in predicting CHD.


The validation statistics indicated that the WHO/ISH risk prediction charts identified cases with CHD with 60.0% sensitivity and 93.2% specificity. At least nine risk factors for developing CHD were detected in all patients in the study cohort. Hypertension was the strongest predictor of CHD [odds ratio (OR) (95% confidence interval (CI)): 20.8 (5.6–76.9)]. Silent cardiovascular risk factors were ascertained in about 30% of the studied population, a finding that did not differ significantly by sex. We propose a different risk assessment model for general practice that incorporates standard cardiovascular risk factors, with or without laboratory tests.


Standard cardiovascular risk factors included in a simple risk prediction algorithm can predict multivariate CHD risk in apparently healthy individuals. Non-laboratory-based risk assessment models have no superior advantage over those employing laboratory investigations.

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Fig. 1
Fig. 2



Alanine aminotransferase


Aspartate aminotransferase


Adult Treatment Panel III


Body mass index


Centers for Disease Control and Prevention


Coronary heart disease


Creatine kinase-muscle/brain


Chronic obstructive pulmonary disease


Creatine phosphokinase


C-reactive protein


Cardiovascular disease


Diastolic blood pressure


Diabetes mellitus




Eastern Mediterranean region (D version)


Fasting blood sugar


Glycosylated hemoglobin concentration


High-density lipoprotein


High-sensitivity C-reactive protein


Ischemic heart disease


Lactate dehydrogenase


Low-density lipoprotein


Non-communicable disease


National Cholesterol Education Program


Peripheral vascular disease


Receiver operating characteristic


Systolic blood pressure


Total cholesterol


World Health Organization/International Society of Hypertension


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Author information

Correspondence to Ekram W. Abd El-Wahab.

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The author declares that she has no conflict of interest.

Ethical approval

The study was approved by the Institutional Review Board and the Ethics Committee of the High Institute of Public Health affiliated to Alexandria University, Egypt. The research was conducted in accordance with the ethical guidelines of the 1964 Helsinki declaration and its later amendments and the International Conference on Harmonization Guidelines for Good Clinical Practice.

Informed consent

All patients were invited to voluntarily sign an informed written consent after explaining the aim and concerns of the study. Data sheets were coded to ensure the anonymity and confidentiality of patients’ data.

ARRIVE guidelines/institutional animal care and use committee statement

The current research did not involve animal work.

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Abd El-Wahab, E.W. Predicting coronary heart disease using risk assessment charts and risk factor categories. J Public Health (Berl.) (2020). https://doi.org/10.1007/s10389-020-01224-z

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  • Coronary heart disease
  • Prediction
  • Risk assessment chart