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. Author manuscript; available in PMC: 2023 Dec 12.
Published in final edited form as: JACC Adv. 2023 Mar 31;2(2):100258. doi: 10.1016/j.jacadv.2023.100258

TABLE 3.

Select Risk Assessment Calculators and Guideline Considerations Specific to South Asian Adults

Risk Calculator Population, Country Number of South Asians in
Derivation Cohort (%)		 Guideline Guideline Commentsa
Pooled cohort equations (PCE)222 Pooled dataset of cohort studies, USA 0%

  • 2018 ACC/AHA Blood Cholesterol Guidelines82

  • 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease223

  • South Asian designated as “White.”

  • South Asian is considered a “risk-enhancing factor:” Class IIa recommendation (where benefit >> risk) for statin considerations in South Asian adults at estimated borderline and intermediate risk.
Systematic COronary Risk Evaluation (SCORE)224 Pooled dataset of cohort studies, Europe 0%

  • 2019 ESC/EAS Guidelines for the Management of Dyslipidemia.225

  • 2021 ESC Guidelines on cardiovascular disease prevention.

  • Multiply risk by 1.3 for Indians and Bangladeshis, and 1.7 for Pakistanis.

  • ‘Other Asian’: multiply risk by 1.1.226
Framingham Risk Score (FRS)227 Population cohort, USA 0%

  • 2012 Australian Absolute CVD Risk Guidelines/National Vascular Disease Prevention Alliance228

  • 2021 Canadian Cardiovascular Society guidelines for the management of dyslipidemia229

  • Australia: for moderate risk (FRS 10-15% absolute risk), consider blood pressure and/or lipid lowering in addition to lifestyle intervention for specific populations (South Asian).

  • Canada: Consider lipid screening ‘earlier’ than age 40 y in men and women.
Modified FRS230 Population cohort, USA 0%

  • 2008 NICE Guideline: Lipid Modification, Cardiovascular risk assessment and the modification of blood lipids for the prevention of cardiovascular disease

  • FRS x 1.4 (South Asian men).

  • No suggestion for South Asian women.
QRISK231 Electronic medical database, UK 0%

  • N/A
QRISK Lifetime/3rd Joint British Societies’ (JBS3) Risk Calculator27,232 Electronic medical database, UK 2.3%
0.3% Bangladeshi;
1.0% Indian;
0.5% Pakistani;
0.5% Other Asian

  • 2014 Joint British Societies Recommendations on the Prevention of Cardiovascular Disease
QRISK2233 Electronic medical database, UK 1.11%
0.16% Bangladeshi (0.26% Women, 0.17% Men);
0.48% Indian (0.47% Women, 0.48% Men);
0.26% Pakistani (0.26% Women, 0.27% Men);
0.21% Other Asian (0.16% Women, 0.19% Men)

  • 2014 NICE Guideline: Lipid Modification, Cardiovascular risk assessment and the modification of blood lipids for the prevention of cardiovascular disease230
QRISK3234 Electronic medical database, UK 5.25%
0.9% Bangladeshi (0.8% Women, 1.1% Men);
2.0% Indian (1.9% Women, 2.1% Men);
1.1% Pakistani (1.0% Women, 1.2% Men);
1.25% Other Asian (1.3% Women, 1.2% Men)

  • N/A
PREDICT30 Electronic medical database, New Zealand “Indian”: 9% (5% Women, 4% Men)

  • 2018 Cardiovascular Disease Risk Assessment and Management for Primary Care235

  • For “South Asian peoples” (Indian, including Fijian Indian, Sri Lankan, Afghani, Bangladeshi, Nepalese, Pakistani, Tibetan), begin CVD risk assessment for men at age 30 y and in women aged 40 y, 15 y earlier than other population groups in New Zealand.
INTERHEART Modifiable Risk Score236 Cases of MI, age (±5 y), and sex-matched control, 52 countries 14%

  • N/A
NORRISK2237 Population-based survey cohort, Norway 0%

  • 2017 Norwegian Directorate of Health, National guidelines for prevention of cardiovascular disease

  • Not validated among South Asian immigrants in Norway.

  • NORRISK2 x 1.4 for all South Asians.
NORRISK2-SADia238 Updated NORRISK2; Population-based survey cohort, Norway. 12% South Asian (5% Women, 7% Men)

  • N/A

  • Developed to include South Asian adults and those with diabetes.
ETHRISK239 Recalibrated FRS, using 2 community-based surveys, UK. 46%
11% Bangladeshi;
20% Indian;
15% Pakistani

  • N/A

  • Developed for British black and ‘minority ethnic’ groups without established diabetes or cardiovascular disease.
UK Prospective Diabetes Study (UKPDS)240 Population Cohort, UK “Asian-Indian”: 10% (3% Women, 7% Men)

  • N/A

  • CVD risk estimate for adults with type 2 diabetes mellitus.
a

If applicable.

ACC = American College of Cardiology; AHA = American Heart Association; CVD = cardiovascular disease; EAS = European Atherosclerosis Society; ESC = European Society of Cardiology; FRS = Framingham Risk Score; MI = myocardial infarction; N/A = not applicable; NICE = National for Health and Clinical Excellence; UK = United Kingdom; USA = United States of America; WHO = World Health Organization.