Heart risk “calculators” overlook risk for people of South Asian descent


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People of South Asian descent have more than twice the risk of developing heart disease compared to people of European descent, although the clinical risk assessment calculators used to guide decisions about heart disease. prevention or treatment of heart disease may not explain the increased risk, according to new research published today in the American Heart Association’s flagship journal Circulation.

About a quarter of the world’s population (1.8 billion people) is of South Asian descent, and previous research has shown that South Asians experience higher rates of disease compared to people of most other ethnicities.

To better understand the variables surrounding the risk of heart disease for people in South Asia , the researchers assessed data from a subgroup of participants in the UK Biobank study who did not have atherosclerotic cardiovascular disease when they enrolled in the study between 2006 and 2010. There were 8,124 participants of southern descent. Asian and 449,349 of European descent included in this analysis. Their average age was 57 years and they were followed by an average of 11 years. People in the South Asian ancestry group were defined as those who declared themselves to be of Indian, Pakistani or Bangladeshi descent or who reported other South Asian heritage, such as their country of birth. with Bhutan, Maldives, Nepal or Sri Lanka. European ancestry was based on personal identification as white British, white Irish or any other European white background.

The researchers compared the rates of development of cardiovascular disease (heart attack, stroke or a procedure to restore normal blood supply to the heart) among people of South Asian descent with the rate of European ancestry.

They found that 6.8% of participants of South Asian descent had a cardiovascular disease event, compared with 4.4% of those who reported having European ancestry. After adjusting for age and sex, this poses more than double the risk for people of South Asian descent. The highest relative risk was largely consistent across several age, sex, and clinical subgroups. However, this increased risk was not captured by clinical estimators used in the United States or Europe.

“Based on previous studies, we expected South Asians to have higher rates of heart disease; in fact, the American Heart Association now considers the South Asian ethnic group to be a ‘risk enhancer’ beyond the standard risk calculator, ”said the study’s lead author, Amit V. Khera. , MD, M.Sc., cardiologist at the Corrigan Minehan Heart Center and leader of a research group at the Center for Genomic Medicine, both at Massachusetts General Hospital in Boston.

“We were amazed at the magnitude of the “Even within contemporary clinical practice, it was more than double,” and how much is still not explained by traditional clinical or lifestyle risk factors, “he said. Our current tools do not help us predict this additional risk in the South Asian population, probably because no South Asian was included in the U.S. tool development, so we may be missing out on opportunities to prevent heart attacks and strokes in this group. Intensive control of risk factors such as high cholesterol and type 2 diabetes are even more important in this population. “

A higher percentage of people in the South Asian study group had higher risk factors for heart disease, including type 2 diabetes (even in the absence of obesity), high blood pressure, and increased blood pressure. central adiposity (belly fat). However, even when the researchers took into account the known risks, the risk for people of South Asian descent was still 45% higher than that of people of European descent.

“We need to dig deeper to better understand why South Asians have heart attacks and strokes at higher rates, even after considering these risk factors,” said Aniruddh P. Patel, MD, lead author of the study and member of cardiology at Massachusetts General Hospital. “Our ability to study populations in South Asia and others in general in the United States through public databases has been limited because individuals are grouped by race rather than ancestry. This makes recognition and resolving these disparities among a harder-growing U.S. South Asian population more difficult.In addition to recruiting more South Asians in clinical trials and cohort studies, better information on ancestry as well as race in systems of hospital data i it would help us better understand and guide these disparities. “

Research has some limitations. The study included adults between the ages of 40 and 69 living in the UK, so the results may not be generalizable to younger people or those living in other countries. In addition, based on the data, it was known that people who volunteered to study the UK Biobank were healthier compared to the general population, so there were potentially reduced rates of in both ancestry groups. In addition, the medical records of study participants were reviewed electronically rather than manually, so that misinformation may have occurred.

Khera and colleagues have assembled a team of international researchers to gather data and experience needed to develop new genetic risk estimators for individuals in South Asia as part of an NIH-funded consortium. In terms of clinical risk estimation tools, South Asians have been severely underrepresented to date, accounting for only 1% of those studied.

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More information:
Circulation (2021). DOI: 10.1161 / CIRCULATIONAHA.120.052430

Citation: Heart risk “calculators” overlook risk for people of South Asian descent (2021, July 12) recovered on July 12, 2021 at https://medicalxpress.com/news/2021- 07-heart-overlook-people-south-asian. html

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