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WHOrisk: WHO Cardiovascular Disease Risk Calculator

An R package implementing the 2019 WHO cardiovascular disease (CVD) risk prediction models for 21 global regions.

Overview

This package calculates 10-year risk of cardiovascular disease (fatal and non-fatal myocardial infarction and stroke) using the WHO risk charts published in The Lancet Global Health (2019).

Reference: > Kaptoge S, Pennells L, De Bacquer D, et al. World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions. Lancet Glob Health. 2019;7(10):e1332-e1345. doi:10.1016/S2214-109X(19)30318-3

Features

Two models available:
- Laboratory-based model (requires cholesterol measurement)
- Non-laboratory-based model (uses BMI instead, suitable for resource-limited settings)
Fully vectorized for efficient batch calculations
Zero dependencies - uses only base R
Automatic country-to-region mapping using ISO 3166-1 alpha-3 country codes
21 global regions with region-specific recalibration

Installation

# Install from source
install.packages("WHOrisk", repos = NULL, type = "source")

# Or using devtools
devtools::install_local("path/to/WHOrisk")

Usage

Laboratory-Based Model

library(WHOrisk)

# Single patient calculation using region
risk <- calculate_who_risk(
  age = 55,
  sex = "male",
  sbp = 140,
  cholesterol = 5.5,  # mmol/L
  smoking = TRUE,
  diabetes = FALSE,
  region = "western_europe"
)
print(paste0("10-year CVD risk: ", round(risk * 100, 1), "%"))

# Using country code instead of region
risk <- calculate_who_risk(
  age = 60,
  sex = "female",
  sbp = 130,
  cholesterol = 6.0,
  smoking = FALSE,
  diabetes = TRUE,
  country = "ITA"  # Italy -> western_europe
)

# Vectorized calculation for multiple patients
risks <- calculate_who_risk(
  age = c(45, 55, 65, 75),
  sex = c("male", "female", "male", "female"),
  sbp = c(120, 140, 160, 150),
  cholesterol = c(5.0, 6.0, 7.0, 5.5),
  smoking = c(FALSE, TRUE, FALSE, FALSE),
  diabetes = c(FALSE, FALSE, TRUE, TRUE),
  country = c("USA", "GBR", "IND", "JPN")
)

Non-Laboratory-Based Model

For settings where cholesterol measurement is not available:

risk <- calculate_who_risk_nonlab(
  age = 55,
  sex = "male",
  sbp = 140,
  bmi = 28,
  smoking = TRUE,
  region = "south_asia"
)

Utility Functions

# Get list of valid regions
get_regions()

# Get country code mappings
get_country_codes()

# Look up specific countries
get_country_codes(c("USA", "GBR", "IND"))

# Map country to region
country_to_region(c("FRA", "DEU", "ITA"))  # All return "western_europe"

Model Details

Variables and Centering

Variable	Laboratory Model	Non-Lab Model	Centered At
Age	✓	✓	60 years
Systolic BP	✓	✓	120 mmHg
Total Cholesterol	✓	-	6 mmol/L
BMI	-	✓	25 kg/m²
Smoking	✓	✓	-
Diabetes	✓	-	-

Valid Ranges

Age: 40-80 years (model derivation range)
Systolic BP: Typically 70-250 mmHg
Cholesterol: 2-12 mmol/L (divide mg/dL by 38.67)
BMI: 12-60 kg/m²

21 Global Regions

Region Code	Description
`north_africa_middle_east`	North Africa and Middle East
`central_subsaharan_africa`	Central Sub-Saharan Africa
`eastern_subsaharan_africa`	Eastern Sub-Saharan Africa
`southern_subsaharan_africa`	Southern Sub-Saharan Africa
`western_subsaharan_africa`	Western Sub-Saharan Africa
`southern_latin_america`	Southern Latin America
`high_income_north_america`	High-income North America
`caribbean`	Caribbean
`andean_latin_america`	Andean Latin America
`central_latin_america`	Central Latin America
`tropical_latin_america`	Tropical Latin America
`east_asia`	East Asia
`south_asia`	South Asia
`southeast_asia`	Southeast Asia
`central_asia`	Central Asia
`high_income_asia_pacific`	High-income Asia Pacific
`western_europe`	Western Europe
`central_europe`	Central Europe
`eastern_europe`	Eastern Europe
`oceania`	Oceania
`australasia`	Australasia

Algorithm

The model calculates separate 10-year risks for: 1. Myocardial infarction / CHD death 2. Stroke

These are combined assuming independence:

P(CVD) = 1 - (1 - P(MI)) × (1 - P(Stroke))

Risk is calculated using Cox proportional hazards:

P(event) = 1 - S₀^exp(LP)

Where: - S₀ = region-specific baseline survival (from GBD incidence data) - LP = linear predictor including main effects and age interactions

Cholesterol Unit Conversion

The model uses mmol/L. To convert from mg/dL:

cholesterol_mmol <- cholesterol_mg_dl / 38.67

Limitations

Age range: Model was derived for ages 40-80. Extrapolation outside this range is less reliable.
Non-laboratory model: Does not include diabetes, so may underestimate risk in diabetic patients.
Regional calibration: Based on 2017 GBD estimates; actual risk may vary by specific country or population.
Risk factors not included: Family history, ethnicity, HDL cholesterol, triglycerides, etc.

License

MIT License. See LICENSE file for details.

The underlying risk models are from the WHO CVD Risk Chart Working Group.

These binaries (installable software) and packages are in development.
They may not be fully stable and should be used with caution. We make no claims about them.
Health stats visible at Monitor.