Assessment of cardiovascular risk in Tunisia: applying the Framingham risk score to national survey data

Objective: This paper aims to assess the socioeconomic determinants of a high 10 year cardiovascular risk in Tunisia. Setting: We used a national population based cross sectional survey conducted in 2005 in Tunisia comprising 7780 subjects. We applied the non-laboratory version of the Framingham equation to estimate the 10 year cardiovascular risk. Participants: 8007 participants, aged 35-74 years, were included in the sample but effective exclusion of individuals with cardiovascular diseases and cancer resulted in 7780 subjects (3326 men and 4454 women) included in the analysis. Results: Mean age was 48.7 years. Women accounted for 50.5% of participants. According to the Framingham equation, 18.1% (17.25-18.9%) of the study population had a high risk (>= 20% within 10 years). The gender difference was striking and statistically significant: 27.2% (25.7-28.7%) of men had a high risk, threefold higher than women (9.7%; 8.8-10.5%). A higher 10 year global cardiovascular risk was associated with social disadvantage in men and women; thus illiterate and divorced individuals, and adults without a professional activity had a significantly higher risk of developing a cardiovascular event in 10 years. Illiterate men were at higher risk than those with secondary and higher education (OR = 7.01; 5.49 to 9.14). The risk in illiterate women was more elevated (OR = 13.57; 7.58 to 24.31). Those living in an urban area had a higher risk (OR = 1.45 (1.19 to 1.76) in men and OR = 1.71 (1.35 to 2.18) in women). Conclusions: The 10 year global cardiovascular risk in the Tunisian population is already substantially high, affecting almost a third of men and 1 in 10 women, and concentrated in those more socially disadvantaged.