Estimating Our Own Cardiovascular Risk

Estimating atherosoclerotic cardiovascular disease (ASCVD) risk is something we can do ourselves, a matka we have control over. 

All we need to know is our blood pressure (which we can measure ourselves at home) and our blood sugar and cholesterol levels (total, HDL and LDL in mg/dl and mmol/litre, which would be mg/dl multiple by 0.025). 

There are many sites where we can plug in this information and get a 10-year risk assessment, with one major caveat. There is no site that has validated data for Indians from India. Sure, if you Google, you may come across sites like  http://www.healthy-india.org/heart_risk_calculator.php, but these have not been validated and should NOT be used. 

A 2017 published study by Garg and his colleagues from PGI Chandigarh [1] showed that the Framingham score works best for Indians. The Framingham score supported by ACC and AHA in the US,  is a simple, elegant and reasonably accurate tool [2] to use for Indians from India (I keep saying this because Indians abroad have a different risk compared to Indians from India). A 2020 study in British South Asians showed that the JBS risk score works best for South Asians in Britain [3]. But this needs Adobe Flash to use online and it is likely that QRisk3, which is a British based validated calculator that includes “Indian” ethnicity, would also work. 

Personally, I have used both QRisk3 and the ACC/AHA calculator and they seem to correlate reasonably well. 

Risk is typically assessed as a percentage over 10 years (e.g. 20% 10-years ASCVD risk). What this means is that if I have a “high” ASCVD risk of 20%, then 20 out of 100 people with the same calculated risk, would have a major cardiac event in the next 10 years. The challenge of course is to figure out whether I am one of those 20 [4]. And that would mean talking to our primary care physician or cardiologist, understanding the risk and then figuring out whether we can further individualize the risk using other techniques such as carotid intima thickness, calcium score of the coronary arteries, ankle-brachial measurements, etc, some of which we will discuss in future newsletters. 

Indians (South Asians) are at a higher risk for CVD and it is very likely that all calculators underestimate our ASCVD risk [5]. Hence, it is a good idea to measure our risk using one of the two calculators I have mentioned and if there is any ASCVD risk, then meet your doctor to see how you can reduce that risk or understand the risk better with more testing.

We have the ability to control one matka…of measuring our ASCVD risk ourselves and we owe it to ourselves to do so.

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Footnotes:

1. Garg N, Muduli SK, Kapoor A, Tewari S, Kumar S, Khanna R, et al. Comparison of different cardiovascular risk score calculators for cardiovascular risk prediction and guideline recommended statin uses. Indian Heart Journal. 2017 Jul;69(4):458–63

2. Durairaj G, Oommen AT, Gopalakrishna Pillai M. A cross-sectional validation study comparing the accuracy of different risk scores in assessing the risk of acute coronary syndrome among patients in a tertiary care hospital in Kerala. Indian Heart Journal. 2020 Mar;72(2):113–8.

3. Findlay SG, Kasliwal RR, Bansal M, Tarique A, Zaman A. A comparison of cardiovascular risk scores in native and migrant South Asian populations. SSM - Population Health. 2020 Aug;11:100594.

4. Bansal M, Agarwala R, Kasliwal RR. Imaging atherosclerosis for cardiovascular risk prediction- in search of the holy grail! Indian Heart Journal. 2018 Sep;70(5):587–92.

5. Kumar A, Shariff M. Atherosclerostic cardiovascular disease risk score: Are Indians underestimating the risk of cardiovascular disease? Indian Heart Journal. 2019 Jul;71(4):364–5.