Lifetime risk among Asian Indians
- Short-term CVD risk assessment tools have been widely used for risk stratification among asymptomatic individuals who are clinically free of CVD. However, a significant proportion of CVD events occur among individuals with a relatively low short-term predicted CVD risk, as many of them become high-risk across the lifespan.1
- Lifetime CVD risk estimation, which measures the cumulative risk of developing the disease during the remainder of an individual’s lifespan, may provide a more appropriate assessment on future CVD risk than short-term (typically 10 year) risk estimates, especially in younger individuals in whom short-term is very low.1
- Short-term CVD risk prediction models discriminate reasonably well across ethnic groups but need to be recalibrated based on the differences in age- and sex specific disease incidence rates of the population in question. Since Indians have been shown to have a higher risk factor burden at younger ages compared with Western populations, risk prediction models developed in Western countries may underestimate short-term CVD risk. Short-term risk prediction models, such as the Framingham Risk Score, have been recalibrated for Indian emigrants to the UK in the ETHRISK calculator and to a small rural population in India.1
- According to the recently published Lifetime Risk model one in two men and three in four women in India had low short-term predicted risk for CVD defined as 10 year risk of CVD <10%. However, two in three men and one in two women had high lifetime predicted risks for CVD. Among men, 35% had low short term and lifetime risk but 30% of this group had high lifetime risk. Among women 75% had low short term and lifetime risk but 65% of this group had high lifetime risk. These data highlight the limitation of short-term risk stratification and the importance of life time risk prediction in the Indian population.1
- In the US, 56% of the adult population is classified as low short-term/high lifetime risk group, compared to 37% for the Indian cohort.2 This group may be a key target for primary CVD preventive efforts, particularly in light of the burgeoning CVD epidemic in India.1
Optimal risk factor levels among Asian Indians
- The vast majority of adults in this population have >1 non-optimal risk factors. Optimal level of all optimal risk factors was found only 15% in India (compared to 11% in the US) which was however, double among those with higher education (21%) compared to those with the lowest education (9%).1
- The maintenance of low risk profile into middle age has been associated with substantially lower rates of CVD across the lifespan, greater longevity, and better quality of life at older ages, and compression of morbidity and reduced medical expenditures later in life.2,3,4
1. Jeemon P, Prabhakaran D, Huffman MD, et al. Distribution of 10-year and lifetime predicted risk for cardiovascular disease in the Indian Sentinel Surveillance Study population (cross-sectional survey results). BMJ Open. Jan 1 2011;1(1):e000068.
2. Lloyd-Jones DM, Leip EP, Larson MG, et al. Prediction of lifetime risk for cardiovascular disease by risk factor burden at 50 years of age. Circulation. Feb 14 2006;113(6):791-798.
3. Lloyd-Jones DM, Dyer AR, Wang R, Daviglus ML, Greenland P. Risk factor burden in middle age and lifetime risks for cardiovascular and non-cardiovascular death (Chicago Heart Association Detection Project in Industry). Am J Cardiol. Feb 15 2007;99(4):535-540.
4. Daviglus ML, Liu K, Pirzada A, et al. Favorable cardiovascular risk profile in middle age and health-related quality of life in older age. Arch Intern Med. Nov 10 2003;163(20):2460-2468.