Cardiovascular Risk Calculators and their Applicability to South Asians

Abstract

Background:: Estimation of absolute cardiovascular disease (CVD) risk and tailoring therapies according to the estimated risk is a fundamental concept in the primary prevention of CVD. Numerous CVD risk scores are currently available for use in various populations but unfortunately, none exists for South Asians who have much higher CVD risk as compared to their western counterparts. Methods:: A literature search was done using PubMed and Google search engines to prepare a narrative review on this topic. Results:: Various currently available CVD risk scores and their pros and cons are summarized. The studies performed in native as well as migrant South Asians evaluating accuracy of these risk scores for estimation of CVD risk are also summarized. The findings of these studies have generally been inconsistent, but it appears that the British risk scores (e.g. QRISK versions) may be more accurate because of inclusion of migrant South Asians in the derivation of these risk scores. However, the lack of any prospective study precludes our ability to draw any firm conclusions. Finally, the potential solution to these challenges, including the role of recalibration and subclinical atherosclerosis imaging, are also discussed. Conclusions:: This review highlights the need to develop large, representative, prospectively followed databases of South Asians providing information on various CVD risk factors and their contribution to incident CVD. Such databases will not only allow development of validated CVD risk scores for South Asians but will also enable application of machine-learning approaches to provide personalized solutions to CVD risk assessment and management in these populations.

Central and local arterial stiffness in White Europeans compared to age-, sex-, and BMI-matched South Asians

“…South Asians demonstrate a higher burden of conventional CVD risk factors than White populations [5][6][7][8]. Traditional CVD risk factors (e.g., obesity, type 2 diabetes mellitus, dyslipidemia, hypertension, and tobacco use) and CVD events present themselves at a younger age [7][8][9][10][11], and contemporary risk prediction models underestimate CVD risk in South Asians [12][13][14]. Possibly, other factors play a role in CVD development in South Asians, which may be reflected by a distinct impact of ethnicity on vascular health [3,10,15].…”