Why heart risk calculators may be failing Indians — Study flags major gap

A major Indian study has raised a critical red flag for heart health: widely used global risk calculators may be missing the majority of Indians who are at risk of a heart attack.

The research, led by Dr Mohit Dayal Gupta at GB Pant Hospital, analysed data from over 5,000 patients and found that nearly 80% of individuals who suffered their first heart attack had not been flagged as high-risk by standard assessment tools.

These findings point to a serious mismatch between how cardiovascular risk is measured globally and how it actually manifests in India.

However, this approach appears insufficient for Indian patients.

In the study, only 11% to 20% of patients were classified as high-risk using these models—despite all of them eventually experiencing a heart attack. This suggests a systemic underestimation of risk.

The issue lies partly in how heart disease behaves differently in India. Unlike Western countries, where cardiovascular disease often develops later in life, Indians tend to experience heart attacks much earlier. The study found the average age to be just 54.

Additionally, several important markers—such as lipoprotein(a), ApoB levels, central obesity, and even chronic kidney disease—are often not adequately included in global risk calculators.

Doctors use them to determine whether patients should be started on preventive therapies like statins, undergo more frequent monitoring, or make aggressive lifestyle changes.

If a patient is incorrectly classified as “low” or “intermediate” risk, critical early interventions may be delayed.

Experts warn that for many Indians, the “intermediate risk” category has become a dangerous grey zone—where underlying risks are present, but not acted upon.

Until such tools are widely developed and adopted, doctors are being advised to go beyond standard calculators and incorporate a more holistic clinical evaluation. This includes:

The takeaway is clear: relying solely on global risk models may not be enough. A more tailored, India-centric approach—combining medical data with clinical judgement—could be key to identifying at-risk individuals earlier and preventing life-threatening events.

For individuals, this also serves as a reminder: “normal” test results do not always mean low risk. A deeper, more personalised assessment could make all the difference.