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Assessment of cardiovascular risk in Tunisia: applying the Framingham risk score to national survey data
  1. O Saidi1,2,
  2. D Malouche1,3,4,5,
  3. M O'Flaherty6,
  4. N Ben Mansour1,2,
  5. H A Skhiri2,
  6. H Ben Romdhane1,
  7. L Bezdah1
  1. 1Faculty of Medicine of Tunis, Cardiovascular Epidemiology and Prevention Research Laboratory, Tunis, Tunisia
  2. 2National Institute of Public Health-Ministry of Health, Tunis, Tunisia
  3. 3MASE-ESSAI, University of Carthage Tunisia, Tunis, Tunisia
  4. 4Research Unity Signals and Systems, ENIT-University El Manar, Tunisia
  5. 5Yale MacMillan Center, USA
  6. 6Department of Public Health and Policy, University of Liverpool, Liverpool, UK
  1. Correspondence to Professor H Ben Romdhane; habibabr{at}


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.

  • 10-year global cardiovascular risk
  • non–laboratory Framingham model
  • socio-economic determinants

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  • Contributors OS, DM and HBR conceived the idea of the study. HAS, LB, OS, NBM and HBR assembled the datasets. OS, DM, NBM, HBR, HAS, LB and MO wrote the first draft of the paper, and finalised the manuscript. All authors contributed to the analysis, intellectual content and critical revisions of the drafts of the paper, and approved the final version. HBR is the guarantor.

  • Funding The study was funded by the European Community's Framework Programme under grant agreement ICA3-CT-2002-1001. The study was also supported by the Tunisian Ministry High Education and Research and Ministry of Health. The research was funded by the European Union (INCO: Med Projects 1998–2002, TAHINA: Epidemiological Transition And Health Impact in North Africa—contract No: ICA3-CT-2002-10011) and supported by the Cardiovascular Epidemiology and Prevention Research Laboratory, Faculty of Medicine of Tunis, University of Tunis El Manar.

  • Competing interests None declared.

  • Ethics approval The study protocol was carried out according to the Declaration of Helsinki and was approved by the Tunisian Ministry of Health and the Tunisian National Council of Statistics (visa No 5/2005).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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