Cardiovascular risk calculator performance in South Asians

Researchers studied 4,975 Indian patients, ages 40–79, who presented with their first heart attack. They retrospectively calculated what each patient’s cardiovascular risk would have been before the event, using five commonly used risk calculators. Only a minority were classified as high-risk: PREVENT: 19.8% Framingham: 20.2% WHO: 15.0% ACC/AHA ASCVD score: 12.3% JBS-3: 11.7% The average age was only 54. So roughly 80% of people who went on to have a heart attack would not have been labeled “high risk” beforehand, even by the best-performing conventional calculators. This does not mean risk calculators are useless. The study looked at people who had already had a heart attack, rather than prospectively following the general population. But it strongly reinforces the need for better South Asian-specific risk prediction. It also supports considering additional markers in selected patients, such as family history, ApoB, Lp(a), metabolic risk and coronary imaging. Bottom line: a “low” or “intermediate” calculator result does not guarantee safety for a South Asian. Know your ApoB, Lp(a) and family history, and discuss further testing with your doctor. Reference: Gupta MD, Kunal S, Girish MP, et al. Comparison of ASCVD Risk Prediction Models in STEMI: Insights From a South Asian Cohort. JACC: Asia. Published online July 20, 2026. doi:10.1016/j.jacasi.2026.03.042