Estimating your own cardiovascular risk

One of the major causes of a reduced lifespan and healthspan is atherosclerotic cardiovascular disease (ASCVD), which can lead to strokes (brain attacks), myocardial infarcts (heart attacks), heart failure and affect many other organs in the body. High blood pressure and diabetes are contributory factors and often the diagnosis and management of ASCVD need a comprehensive evaluation of multiple risk factors.

Unfortunately, there are no validated Indian calculators to help with risk assessment, irrespective of what you may find on the Internet. There are three major internationally validated calculators, the Framingham Score, supported by the American College of Cardiology (ACC) and American Heart Association (AHA), SCORE, used in the European Union and QRisk3, a UK based calculator. Of these QRisk3 is the only one that has some “Indian / South Asian” representation (though these are UK Indians / South Asians) [1]. I have used all 3 and by and large they give similar results, though more and more, Indian researchers are using QRisk3 to estimate ASCVD risk among Indians in India [2].

We don’t have enough doctors in India for treatment, forget prevention. While some of you may be fortunate to have family physicians or cardiologists who are obsessive about assessing and managing your cardiovascular risk, most of you would not have that luxury. More importantly, you have to take care of your health yourself…no else is going to do it for you, until you fall sick. The whole idea of Atmasvasth is to live long healthy, as far as possible, without relying on the healthcare system.

You can measure your own ASCVD risk using any of these calculators, preferably QRisk3. What you need to know in advance is your blood pressure (which also you can measure yourself at home) and your blood sugar and cholesterol levels, which you can get done on your own at any good laboratory.

Risk is typically assessed as a percentage over 10 years (e.g. 20% 10-years ASCVD risk). A 20%, 10-years risk, means that if there are 100 people in the room, all with a 20% ASCVD risk, then 20 of them in the next 10 years will land up with a major event such as a heart attack or a brain attack.

If your risk is low (less than 5% or a relative risk < 1 compared to people of the same age, sex and ethnicity), then you don’t have to worry much, though you should still continue to be or start being physically active, eat sensibly, not smoke, sleep well and control high blood pressure and diabetes, if present. If however, your risk is high (more than 10%), then it is a good idea to see a doctor to initiate strategies to reduce your risk. More importantly, you can keep measuring your ASCVD risk on your own once a year and if you find your risk increasing or if you were at high risk, but the risk has not reduced, you can again see your doctor to initiate more aggressive risk mitigation measures.

The only person who can take care of your health is you or perhaps a near and dear one. Doctors will help you when you fall sick, or when you go to them with specific questions, but living long healthy is something you have to do on your own. The Atmasvasth guide can help you along the way. Estimating your own cardiovascular risk is something you can and should do on your own so that you can find out for yourself if you are at risk or not and if so, initiate steps along with your doctor to reduce that risk to prevent escalation to full-blown disease that can potentially cut short your life in the future.

Footnotes

1. Findlay SG, Kasliwal RR, Bansal M, Tarique A, Zaman A. A comparison of cardiovascular risk scores in native and migrant South Asian populations. SSM – Population Health. 2020 Aug;11:100594.

2. Unnikrishnan AG et al. Cardiovascular risk in newly diagnosed type 2 diabetes patients in India. PLoS One. 2022 Mar 31;17(3

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