Cardiovascular risk assessment of South Asians in a religious setting: a feasibility study

Abstract

Summary Aims: South Asians in the UK have high cardiovascular disease (CVD) mortality. Therefore, this population is likely to benefit from screening programmes. To address this issue, an initiative was set up between the Royal Free Hampstead NHS Trust, H.E.A.R.T. UK and two Hindu temples in North London to provide screening for CVD risk factors in the community. Methods: A total of 434 individuals of Gujarati Indian origin were screened. Measurements included anthropometry, blood pressure and lipid profiles. Three different scoring systems: Framingham, Joint British Societies’ 2 and QRISK2 were used to estimate CVD risk. Results: At least one modifiable CVD risk factor was present in 92% of the individuals screened; 52% were hypertensive, 40% were obese, 75% had central adiposity and 10% had total cholesterol/high density lipoprotein cholesterol ratio > 6. In addition, 37% of a subset of 104 individuals with a fasting sample fulfilled the diagnostic criteria for metabolic syndrome. Overall, 15% of participants screened had a 10‐year CV risk score > 20% using QRISK2. The three risk score calculators showed moderate agreement: QRISK2 and JBS2 (kappa 0.61, 95% CI 0.54–0.67), QRISK2 and Framingham (kappa 0.63, 95% CI 0.57–0.70) and JBS2 and Framingham (kappa 0.70, 95% CI 0.64–0.75). Conclusions: A high prevalence of modifiable risk factors for CVD was detected in the population screened.

Feasibility of community-based screening for cardiovascular disease risk in an ethnic community: the South Asian Cardiovascular Health Assessment and Management Program (SA-CHAMP)

“…Davachi et al [46] demonstrated that when diabetes screening sessions for those without known diabetes were held in the context of religious gatherings in temples and mosques in Calgary, Alberta, it was highly acceptable to community members and is reflected in the high participation rate (922 screened in 14 four hour screening sessions). Similarly, Rao et al [45] screened for CVD risk in two Hindu temples in London, England. In this study medical/paramedical community members were able to screen 434 self-selected participants in 9 six-hour sessions.…”

“…Using a methodology similar to ours, Davachi et al [46] opportunistically screened adult non-diabetic SA for diabetes in places of worship, and observed very high rates of obesity (67%), family history of diabetes (43%) and results suggestive of potential glucose intolerance (36%). Despite excluding of those with self reported CVD, hypertension, diabetes or use of lipid therapy, [45] Rao et al found that 52% of participants had hypertension, 75% had central obesity, 10% had TC/HDL ratios > 6, and 15% were assessed as high risk using the QRISK2 model for 10-year CVD risk. The higher prevalence of both poorly controlled risk factors and 10-year CVD risk among participants in our study are consistent with their higher average age and their relatively high prevalence of self-reported CVD (10%), diabetes (23%), hypertension (52%) and dyslipidemia (49%).…”

“…Many exemplar CVD screening and intervention programs originating in Canada, [31,32] the United States [25,28,33-35], the United Kingdom [36-38], India [39] and Pakistan [40] have employed a variety of personnel (peer educators, community health workers, trained barbers, medical/paramedical volunteers) in religious settings [19,20,41-45] to improve cardiovascular health among various minority groups, including African Americans, Hispanics, older adults and low income women. However, short of a similar diabetes program [46], to the best of our knowledge, global CVD risk screening and education programs for SAs that are led by trained lay community volunteers in religious settings have not been implemented in Canada.…”

Moving the goalposts - towards cardiovascular prevention

“…Non‐traditional screening strategies such as the use of religious meeting places (e.g. Hindu temples) seems to ameliorate this selection bias .…”

QRisk superior in diverse South Asian groups - response to Robson et al.

“…Because South Indian Asians have a greater risk of vascular events (2), it is imperative to validate a risk engine specifically aimed at this population living in India and in other countries where substantial migration has occurred (e.g. UK, USA).…”