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 Table of Contents  
EDITORIAL COMMENTARY
Year : 2016  |  Volume : 4  |  Issue : 1  |  Page : 3-4

Cardiovascular risk screening: Time for a wakeup call!


Department of Cardiology, King George Medical University, Lucknow, Uttar Pradesh, India

Date of Web Publication4-Mar-2016

Correspondence Address:
Akshyaya Pradhan
Department of Cardiology, King George Medical University, Lucknow, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2321-449X.178116

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How to cite this article:
Pradhan A. Cardiovascular risk screening: Time for a wakeup call!. Heart India 2016;4:3-4

How to cite this URL:
Pradhan A. Cardiovascular risk screening: Time for a wakeup call!. Heart India [serial online] 2016 [cited 2020 Jul 15];4:3-4. Available from: http://www.heartindia.net/text.asp?2016/4/1/3/178116

Ischemic heart disease (IHD) is now ranked first among causes of mortality throughout the world beating stroke and infections. Between 1990 and 2010, the global burden of IHD has increased by 30% despite a decrease in the incidence of myocardial infarction and prevalence of angina.[1] This was attributable primarily to an aging population and a lesser extent to population growth. Alarmingly, despite a declining trend in IHD mortality in developed countries, the South Asian region fared worse.[2] Not only did the region have a maximum number of IHD deaths but the deaths occurred at a younger age too. To add to our woes, Yusuf et al. have described the under usage of drugs for secondary prevention of cardiovascular (CV) disease the problem being worse in low-income countries and rural areas.[3] Indian data also mirror similar trends. The CREATE investigators described lower use of reperfusion therapy and guideline-directed medical therapy in IHD patients.[4] Where do we go from here?

CV risk screening then becomes an integral part of IHD management armamentarium. It is an important tool for detection of high-risk IHD patients and implementation of measures to diminish the risk of future CV events. A lot of risk screening tools are in vogue but which one to choose? Framingham risk scoring system remains by far the most popular. However, it has got several limitations and systematically underestimates risk in South Asians including Indians.[5],[6] Only World Health Organization-International Society of Hypertension (WHO-ISH) risk prediction score and 3rd Joint British Societies-III (JBS-III) risk score have incorporated South Asian or Indian population and are relevant to us.[7],[8] Preliminary data suggest some evidence favoring JBS-III score.[9]

In this issue of journal, authors report the use of WHO-ISH risk prediction chart in South Indian young population for assessment for CV risk.[11] The authors reassuringly report a low incidence of diabetes, hypertension, and tobacco intake. However, around 2% of population (aged >40 years) had high 10 years CV risk despite the young age and negligible presence of conventional risk factors. These observations need to be confirmed in a larger patient population. This could be the tip of iceberg only. Gupta et al. recently described the higher prevalence of cardiometabolic risk factors in Indians and progressive rise in obesity, systolic blood pressure, and smoking over the years.[10] The need of the hour is definitely to perform large and prospective studies for assessing CV risk in our population and to choose the ideal risk assessment tool. This will set the stage for research on various methods of risk reduction in next stage. A robust data on the prevalence of risk factors, CV risk and IHD burden in our population will enable us to convince ourselves and our peers about the need for routine risk assessment and implantation of relevant prevention strategies.

”What the mind does not know, the eyes cannot see.”

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Moran AE, Forouzanfar MH, Roth GA, Mensah GA, Ezzati M, Flaxman A, et al. The global burden of ischemic heart disease in 1990 and 2010: The global burden of disease 2010 study. Circulation 2014;129:1493-501.  Back to cited text no. 1
    
2.
Moran AE, Forouzanfar MH, Roth GA, Mensah GA, Ezzati M, Murray CJ, et al. Temporal trends in ischemic heart disease mortality in 21 world regions, 1980 to 2010: The global burden of disease 2010 study. Circulation 2014;129:1483-92.  Back to cited text no. 2
    
3.
Yusuf S, Islam S, Chow CK, Rangarajan S, Dagenais G, Diaz R, et al. Use of secondary prevention drugs for cardiovascular disease in the community in high-income, middle-income, and low-income countries (the PURE Study): A prospective epidemiological survey. Lancet 2011;378:1231-43.  Back to cited text no. 3
[PUBMED]    
4.
Xavier D, Pais P, Devereaux PJ, Xie C, Prabhakaran D, Reddy KS, et al. Treatment and outcomes of acute coronary syndromes in India (CREATE): A prospective analysis of registry data. Lancet 2008;371:1435-42.  Back to cited text no. 4
[PUBMED]    
5.
Chia YC. Review of tools of cardiovascular disease risk stratification: Interpretation, customisation and application in clinical practice. Singapore Med J 2011;52:116-23.  Back to cited text no. 5
    
6.
Bansal M, Shrivastava S, Mehrotra R, Agarwal V, Kasliwal RR. Low Framingham risk score despite high prevalence of metabolic syndrome in asymptomatic North-Indian population. J Assoc Physicians India 2009;57:17-22.  Back to cited text no. 6
    
7.
World Health Organization. Prevention of Cardiovascular Disease Guidelines for Assessment and Management of Cardiovascular Risk. Geneva: WHO; 2007.  Back to cited text no. 7
    
8.
JBS Board. Joint British Societies' consensus recommendations for the prevention of cardiovascular disease (JBS3). Heart 2014;100 Suppl 2:ii1-67.  Back to cited text no. 8
    
9.
Bansal M, Kasliwal RR, Trehan N. Comparative accuracy of different risk scores in assessing cardiovascular risk in Indians: A study in patients with first myocardial infarction. Indian Heart J 2014;66:580-6.  Back to cited text no. 9
    
10.
Gupta R, Guptha S, Gupta VP, Agrawal A, Gaur K, Deedwania PC. Twenty-year trends in cardiovascular risk factors in India and influence of educational status. Eur J Prev Cardiol 2012;19:1258-71.  Back to cited text no. 10
    
11.
Savitharani BB, Madhu B, Renuka M, Sridevi, Ashok NC. Utilization of WHO-ISH 10 year CVR risk prediction chart as a screening tool among supporting staff of a Tertiary Care Hospital, Mysuru, India. Heart India 2016;4:13-6.  Back to cited text no. 11
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