Are Doctors missing Heart Attack Warnings in Indian Patients?

A major Indian study has revealed that nearly 80% of patients who suffered their first heart attack were not identified as high-risk by standard global calculators.

The retrospective analysis examined over 5,000 patients and raises urgent questions about how cardiovascular risk is assessed in Indian populations.

Led by Dr Mohit Dayal Gupta at GB Pant Hospital in Delhi, the research highlights significant gaps in widely used Western-developed models.

These include tools such as the Framingham Risk Score, QRISK, ASCVD Risk Estimator, and SCORE, which rely on traditional indicators like age, cholesterol, and blood pressure.

However, the study found that only 11% to 20% of Indian patients who later experienced heart attacks were classified as high-risk beforehand.

All of those patients went on to suffer a first heart attack, exposing widespread misclassification and missed opportunities for prevention.

Researchers say the findings underline how global models, largely built on Western cohorts, fail to reflect the realities of Indian cardiovascular health.

One major difference lies in the age of onset, as heart disease in Western populations often emerges after the age of 60.

In contrast, the average age of heart attack in the study was around 54, with many cases occurring even earlier.

Dr Gupta explained that Indian patients present unique risk patterns that are not adequately captured by existing tools.

He noted that Indian populations often develop cardiovascular disease earlier and with different underlying metabolic characteristics.

This has been described as the “South Asian phenotype”, which includes several distinct and often overlooked risk factors.

Many individuals may appear lean but still carry hidden abdominal fat, known as central obesity, which significantly increases cardiovascular risk.

Insulin resistance and diabetes are also more common in non-obese individuals, challenging conventional assumptions about body weight and health.

Additionally, patients frequently exhibit low levels of HDL cholesterol and high triglycerides, even when LDL cholesterol appears within normal ranges.

Genetic and metabolic markers such as Lp(a), ApoB, and small dense LDL further complicate the picture but are not included in most global calculators.

Lifestyle and social factors also play a role, including high stress levels, smoking, and increasingly sedentary habits.

Together, these elements create a risk profile that is both complex and poorly represented in existing scoring systems.

Cardiology experts have long argued that ethnic-specific tools are needed to improve accuracy and outcomes.

Previous research published in leading journals has also pointed to the underrepresentation of South Asians in cardiovascular modelling.

The consequences of this misclassification are significant, particularly when it comes to early prevention.

Patients placed in the “intermediate risk” category often do not receive timely interventions such as statins or targeted lifestyle guidance.

As a result, thousands may miss the chance to reduce their risk before a serious cardiac event occurs.

The study strengthens calls for India-specific or South Asian-calibrated risk calculators that go beyond traditional factors.

Experts suggest incorporating genetic markers, metabolic indicators, and lifestyle elements to create a more accurate and personalised assessment.

Clinicians are also being urged to exercise caution when using global tools and to consider additional factors in their evaluations.

These include family history of heart disease, early-onset diabetes, waist circumference, and levels of physical activity and stress.

Public health messaging is another key area of focus, particularly around early screening.

Researchers recommend that individuals begin regular cardiovascular checks in their 30s or 40s, even if they appear healthy.

For British South Asians, the findings are particularly relevant and concerning.

Studies in the UK have already shown that South Asians face a higher risk of premature heart disease compared to white Europeans.

This often occurs even when cholesterol levels and body mass index appear similar.

Shared cultural factors, including diet, work pressures, and genetic predispositions, further contribute to this elevated risk.

The Delhi study, therefore, reinforces a growing global consensus that one-size-fits-all models are no longer sufficient.

Instead, more tailored approaches are needed to address the specific health challenges faced by South Asian communities.

As awareness grows, experts hope that earlier detection and more personalised care will help reduce the burden of heart disease across generations.