A comparison of cardiovascular risk scores in native and migrant South Asian populations

BACKGROUND: South Asians have increased cardiovascular risk burden but little data exists comparing cardiovascular (CV) risk models in migrant and native South Asians. Our retrospective cohort study in patients presenting with first acute myocardial infarction(MI) compares the predictive value of CV risk scores in native and UK migrant South Asians. METHODS: Retrospective cohort study of 80 UK-based patients of South Asian origin admitted with first presentation MI, excluding patients with known coronary artery disease. A retrospective 10-year CV risk was calculated for each patient using four cardiovascular risk models: Framingham Risk Score(Risk(FRS)), World Health Organisation(Risk(WHO)), American College of Cardiology/American Heart Association(ACC/AHA) (Risk(ACC/AHA)), and 3(rd)Joint British Societies'(Risk(JBS)). Our aim was to assess agreement between these risk scores and conduct comparative analysis with native South Asians. RESULTS: Risk(JBS) identified the largest proportion of migrant South Asians as ‘high risk’ with 65% of subjects having an estimated >20% 10-year CV risk. Risk(WHO) provided the lowest 10-year CV risk estimates for South Asian migrants, identifying 21.25% of the migrant cohort as >20% risk of major CV event. Comparative analysis with the native South Asian cohort demonstrated Risk(JBS) as the risk model most likely to identify patients as ‘high'(>20%) risk(55.9%; p = 0.224). CONCLUSIONS: This study represents the first analysis of predictive cardiovascular risk scores comparing migrant and native South Asian populations. Significant variation between the CV risk scores were observed, leading to inaccuracies in patient cardiovascular risk estimation. Given the growing burden of cardiovascular disease in Asian countries and different population characteristics, we highlight the need for population specific CV disease risk models whilst providing stimulus for further large-scale prospective studies.