Getting to the heart of the matter … Professor Stephen Harrap.TENS of thousands of Australians could have undiscovered heart disease because the key method used by doctors to assess patients is outdated and grossly underestimates risk, a leading hypertension specialist says.
Nanjing Night Net

The International Society of Hypertension hosted its annual conference in Sydney this week and its president in Australia, Stephen Harrap, said doctors were estimating heart disease risk based on a study conducted six decades ago.

The standard method of testing did not consider a person’s socio-economic situation, he said, even though poorer people had a higher risk of developing heart disease due to less access to information and health care as well as higher levels of anxiety and depression.

”These people are living shorter lives because of their socio-economic status and we’re talking amounts of 15 to 20 years less than those elsewhere in Australia,” Professor Harrap said. ”Not only do they die younger, they suffer over a much longer period.”

Called the Framingham Score, the method is designed for adults aged 20 and older who do not have heart disease or diabetes but was tailored towards patients who were relatively well-off, Professor Harrap said.

It involves measuring blood pressure, cholesterol, body weight, age, sex and other things that feed into a formula designed to estimate a patient’s ”score” or risk of dying from cardiovascular disease.

”But the score was developed long ago from a study of well-off people in a small town in Massachusetts and is not appropriate to people living in big cities, where there are less well-off pockets, indigenous communities or people living in the red-centre – even though those people share the greatest burden of cardiovascular disease,” Professor Harrap said.

”If you were to measure the blood pressure and cholesterol in a poor person based on the Framingham Score it may tell you their risk is 10 per cent but in reality that risk might be 30 per cent.”

Although the impact of being poor on health was now widely recognised in scientific research, Professor Harrap said it could take decades for that research to result in new tools widely used by doctors to better assess risk.

The director of the Baker IDI Heart and Diabetes Institute, Garry Jennings, agreed the score was based on ”old technology” developed when obesity, another risk factor, was uncommon.

”But at the moment Framingham is the best diagnostic tool we’ve got,” Professor Jennings said. ”It doesn’t apply to very high risk groups and also doesn’t work so well in those with major psychiatric disease, kidney problems and those with inflammatory diseases.”

Programs carried out beyond the doctors office were needed to reach the most high-risk populations, he said, such as mobile clinics that went to people’s workplaces and education targeted at poorer populations.

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