It goes beyond the Framingham model
A newer cardiac risk score that expands on the classic Framingham assessment model could be more relevant for profiling the South Asian population, which has been estimated to be at increased risk of heart disease, Seshasayee Narasimhan, cardiology consultant with the University of Alberta, Edmonton, Canada, has said.
The Framingham tool, if applied as it is, could lead to an underestimation of the risk among South Asians who make up 25 per cent of the global population and also contribute to about 60 per cent of the global cardio-vascular disease burden, Dr. Narasimhan told The Hindu.
The cardiologist, an alumnus of the Stanley Medical College (the 1992 batch), has reviewed epidemiological evidence and built on cardiac risk profiling from various parts of the world to put together a new score that factors in the ethno-genetic traits believed to make South Asians more vulnerable to ischemic heart disease.
Dr. Narasimhan advocates an expanded Framingham scale that goes beyond the basic criteria — age, gender, total cholesterol, smoking, HDL cholesterol, systolic blood pressure — to include eight more parameters such as a revised Body Mass Index (18.5 per 23 instead of the conventional 22-26 range), reduced adiponectin and lipoprotein and raised levels of homocysteine and apolipoprotein (ApoB100).
According to Dr. Narasimhan, the key features of heart disease in a country like India is that the onset of acute coronary syndrome happens much earlier (under 40 years of age) than in the Western population, besides its presentation as a severe and diffuse coronary artery disease.
“While it is not uncommon here to meet 30 to 40-year-old persons who have undergone a bypass surgery, such an event in this age group is a rarity in the West.”
What is most worrying is the lack of adequate awareness of cardio-vascular risks, both at the community level and among medical professionals. Pointing out that lifestyle behaviour and dietary habits are often rooted in ethnic-specific beliefs, Dr. Narasimhan advocates community-level awareness interventions that recognise this fact.
He plans to hold free medical camps in Chennai, apart from Bangalore and Hyderabad, for two weeks every year as a measure of giving back to the community and spreading the message of a healthy heart.