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Updated: August 6, 2011 10:47 IST

New cardiac risk score for South Asians

M. Dinesh Varma
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Dr. Seshasayee Narasimhan, Interventional Cardiologist, University of Alberta, Edmonton, Canada. Photo: V. Ganesan.
The Hindu Dr. Seshasayee Narasimhan, Interventional Cardiologist, University of Alberta, Edmonton, Canada. Photo: V. Ganesan.

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.

There are so many studies looked into stress as the cause of heart disease but never proved in any study. It's a myth in our community that stress causes high blood presure and heart disease. Even if you conduct more studies until you manipulate the data, you won't be able to find an association.We are more prone simply because of the environmental factors acting on our genetic make up. One person will be very obese, indulge in alcohol and heavy smoking but he may never get heart disease in his life whereas the other person who is young and slim, eat sensibly can get it before 40 years.How to identify these people is the risk scores and furhter research into genes.Until we find the specific gene we should stress the whole population to adopt healthy lifestyle.Regarding stents it does change the course of life only in Acute heart attack. But unfortunately in our country we put stents for stable patients which is of no prognostic value. pacemakers we should form a fund and donate to needy

from:  R.Manivarmane
Posted on: Jul 20, 2011 at 18:58 IST

Dear Doctor, I saw a modified form of Framingham tool to assess cardiac risk.Why cant we include Diabetes Mellitus, Alcoholism and Stress factors in the basic criteria.If any epidemiological study supports this, it may be considered. Plenty of cardio protective and cardiac tonics medicines also told in ancient Siddha literatures are being applied in medical practice also. If you conduct any research in this area in future, my suggestions can also be considered to establish and highlight the scientific base of our Tamil/ Siddha tradition.

Dr.K.Jagannathan, MD(Siddha), PhD
Reader & HOD, Department of General Medicine,
Santhigiri Siddha Medical College, Thiruvananthapuram
Research Officer, Santhigiri Research Foundation, Thiruvananthapuram

from:  Jagannthan
Posted on: Jul 18, 2011 at 08:25 IST

It is true and once again proven by the author that Indains are more prone to IHD and other Cardio vascular Disease affecting mortality and mandays lost due to burden of the Disease, It is still irony that in most of the cases it remains undiagonised. Being a healthcare preofessional and related in Cardiac disease management it has become imperative to incerease the awareness level and Govt. should play a povital role in bringing down the prices of cardiac Implants like Stents, pacemaker and ICD etc.
The alrming fact is that in rural area the Disease has made inroad causing sudden death due to lack of facility as well awarness as well economic disparity.

from:  Arun Kumar Singh
Posted on: Jul 17, 2011 at 20:01 IST

Of course South Asians are more prone for IHD. Apart from the added risk factors for South Asians mentioned in the article, we can add stress as a major factor. While a 40 year old in the west (especially North America)has no survival worries. In India survival is an issue. The work load of an IT professional in India is at least 3 times more stressful and he gets paid less too. That must be the case in other professions also. Has anybody done any work on this angle? Survival or competition pressure? I have traveled and have found that westerners definitely have more leisure and it has something to do with a sense of security. Even a menial worker finds time to go on a camping trip in a week-end or a trip abroad once in 3 years. But an average working Indian will not be able to do that due to a sense of insecurity fiscal or psychological.

from:  Devidas M
Posted on: Jul 16, 2011 at 10:26 IST

I like the fact that the good Doctor is doing all this to raise awareness of cardiovascular disease that, we as South Asians are more vulnerable to, and doing this to give back to his Indian community in India.

from:  Srikanth
Posted on: Jul 16, 2011 at 09:17 IST
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