Affordable cardiovascular testing can encourage screenings

India is witnessing a significant increase in cardiovascular illnesses, affecting people across all age groups, including a rise in young adults. Factors such as sedentary lifestyles, unhealthy dietary habits, stress, and genetic predisposition contribute to this alarming trend.

On the occasion of World Heart Day, celebrated on 29th September, India Business and Trade conducted an exclusive interview with Dr. Sohini Sengupta, Medical Laboratory Director at RedCliffe Labs. The discussion revolved around the potential of emerging innovative technologies to offer valuable insights into cardiac health and mitigate premature deaths.

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IBT: How does clinical biochemistry contribute to the early diagnosis and management of cardiovascular diseases, which are the leading cause of death worldwide?

Dr. Sohini Sengupta: So, we all know that the burden of cardiovascular diseases has increased tremendously. While it is said that in developed countries, it has somewhat flattened, in low and middle-income countries, including India, there is a steep rise. Obviously, the role of the laboratory, and particularly clinical biochemistry, comes into play here to facilitate early diagnosis to assist in prevention as well as treatment. The primary goal of prevention is to reduce both morbidity and mortality. According to the American Heart Association’s 2019 guidelines, they suggest that after the age of 20, it is very reasonable to measure traditional risk factors every 4 to 6 years.”

That includes hypertension, which is high blood pressure, diabetes, and altered lipid parameters such as high cholesterol; these factors contribute to cardiovascular diseases. According to the American Heart Association’s advice, adults should undergo testing for traditional risk factors every four to six years after the age of 20. These tests should include regular monitoring of blood pressure, blood glucose, blood cholesterol, and body mass index. These are the basic requirements, the minimum ones. In addition to these, a clinical biochemistry laboratory can perform a more extensive diabetic profile test, which includes fasting and random glucose levels, glycosylated haemoglobin, and lipid profiles. The lipid profile includes measurements of triglycerides, total cholesterol, LDL cholesterol (traditionally known as the ‘bad’ cholesterol), and HDL cholesterol (the ‘good’ cholesterol).

So, in summary, the testing comprises three main components: the diabetic profile, the lipid profile, and blood pressure monitoring, as previously mentioned. Additionally, there are advanced lipid parameter tests, which encompass Apolipoprotein A, Apolipoprotein B, lipoprotein A, homocysteine, and more.”

Now, we also have newer markers that have long been used for the diagnosis of heart disease. For instance, when someone experiences a heart attack, they are typically checked for certain diagnostic markers, such as high-sensitivity troponin I, which is also known as hsTropL or NTproBNP. However, their utility has now been extended to be valuable for predictive cardiac risk assessment as well. What we have started offering now is HS troponin I for asymptomatic individuals and NTproBNP for diabetic individuals to assess their cardiac risk. These are essentially the tests that our laboratory provides for cardiac risk assessment.”

IBT: In your view how is the growing role of diagnostics lowering the costs of healthcare and empowering consumers to monitor and track their health to protect their well-being and boost their prosperity?

Dr. Sohini Sengupta: The fundamental concept is that people will only undergo screening or risk assessment tests if they are affordable. Therefore, our primary goal at RedCliffe is to ensure that these tests are not only easily accessible but also affordable for the Indian population. This approach will encourage individuals to step forward and undergo screening, thereby facilitating the early detection of diseases and ultimately aiding in the prevention of morbidity and mortality, as I mentioned earlier.

At RedCliffe, our approach has been twofold. Firstly, we’ve aimed to reach deeper into Bharat, encompassing tier two, tier three, and tier four cities, in order to make diagnostics easily accessible to these areas. Secondly, we’ve focused on reducing the cost of tests. As we are aware, a significant portion of the Indian population cannot afford expensive testing, which often leads to many non-communicable diseases, with cardiovascular diseases being one of the most significant, going undetected or unaddressed.

To address this issue, we have actively worked to lower the cost of our tests, making them more affordable for the general population. Additionally, we’ve harnessed the power of technology. Even in the more remote parts of India, including smaller towns and cities, most people have access to a mobile phone. Leveraging this, we have developed a mobile app and established an extensive online presence, making it convenient for individuals to book tests without the need for extensive travel.

They can easily book a test using a mobile phone or a computer. Additionally, we have an extensive network of phlebotomists who visit homes for sample collection. Therefore, our approach encompasses three key aspects: accessibility, affordability, and the utilization of technology to provide at-home testing. We leverage our wide network of phlebotomists to facilitate home collection, enabling a large number of people to undergo screening for various cardiovascular markers and risk assessments that they might not have otherwise pursued.

IBT: Given your expertise in special assays, are there any innovative or emerging laboratory tests that can provide valuable insights into cardiac health and risk assessment?

Dr. Sohini Sengupta: Yes, as I mentioned earlier, certain tests traditionally used for diagnosing conditions like a heart attack or myocardial infarction, commonly known as cardiac arrest or heart failure, have evolved in their utility. They are now applied for preventive health checks and serve as predictive risk markers for cardiac health. I’ll provide two common examples, both of which we’ve also started offering at RedCliffe: high-sensitivity troponin I (HS troponin I) and NTproBNP. These tests were previously used primarily for diagnosing cardiac risk. However, by adjusting their cutoff values, we are now using them for cardiac risk assessment.

For example, in the case of HS troponin I, we use it to screen asymptomatic individuals, meaning the general population without any history of cardiac events or complaints. The cutoff values for these individuals vary, and depending on their test results, they are categorized as low risk, moderate risk, or high risk. The value of HS troponin I should be correlated with their clinical findings, whether the clinician suspects any issues or not.

If they fall into the low-risk category, they can undergo testing every four to six years with no significant concerns. If they are in the moderate range, it suggests the possibility of subclinical myocardial injury. In such cases, individuals should adopt a healthier lifestyle, monitor their lipid and blood pressure regularly, and repeat the HS troponin I test along with ECG or echocardiography as recommended by their doctor every four to six months.

However, if they fall into the high-risk category, it indicates the potential for subclinical myocardial damage or heart damage. In such instances, the results should not be considered in isolation but should be assessed in conjunction with the patient’s clinical symptoms and presentations. Additional tests are required, and therapeutic or preventive interventions suggested by the doctor should be followed. The patient should then recheck themselves after four to six weeks.

Similarly, NTproBNP, traditionally used as a marker for heart failure, has seen changes in its cutoff values. It is now used for cardiac risk assessment and risk stratification, especially in diabetics, as a predictive marker for heart disease.”

If a person is categorized as low risk, they are encouraged to undergo testing after a year. However, for those at high risk, therapy optimization needs to be considered, in conjunction with other clinical presentations and additional heart-related tests, in order to prevent the occurrence of a future heart attack or heart failure. Essentially, the goal is to prevent any cardiac events in the future.

In essence, what we are accomplishing is the use of these newer predictive risk assessment markers to facilitate screening in the asymptomatic general population. This way, individuals who may be at risk can be detected early, allowing them to make lifestyle modifications and adopt interventions promptly to prevent both morbidity and mortality.

IBT: How has the role of laboratory medicine evolved in recent years in the context of cardiovascular health, and what impact has it had on early detection and treatment?

Dr. Sohini Sengupta: As I’ve previously mentioned, laboratories have adopted innovative approaches. We are not solely reliant on traditional or conventional risk factors, nor are we limited to detecting these factors using conventional tests like a diabetic profile, lipid profile, routine urine microscopy, microalbuminuria assessment, serum creatinine measurement, or blood pressure monitoring. Our approach is not limited to these conventional tests alone. Instead, we also incorporate newer markers. These markers serve a dual purpose – not only diagnosing a patient after they have experienced a cardiac event but also predicting the likelihood of that person experiencing a cardiac event in the near future.

I believe these are the innovations that laboratory medicine, in a broader sense, has embraced to facilitate risk assessment. I would say that, more than just diagnosis, our goal now is to reduce the global burden of this epidemic of cardiovascular diseases. This is particularly crucial in India, where we need to screen larger segments of the population. This includes not only the asymptomatic general population but also individuals at risk due to factors such as an unhealthy or sedentary lifestyle, alcohol and tobacco usage, and a strong genetic predisposition, such as those with a significant family history of cardiac events. These are the individuals who should undergo testing.

Our approach involves adopting these innovations to streamline the screening process for both the general population and those at risk. The aim is to identify potential issues early and assist individuals in adopting preventive measures to either halt or delay the progression of these conditions.

IBT: Given your involvement in international committees like IFCC, what is the global perspective on improving laboratory diagnostics for heart diseases, and how does India contribute to this effort?

Dr. Sohini Sengupta: You see, we are actively involved in various IFCC committees, convening regularly for discussions. In these committees, we strive to ensure accurate diagnoses and place significant emphasis on prevention. From a global perspective, India aligns with the idea that we should prioritize preventive risk assessment blood tests. These tests facilitate early screening and detection.

India is, in many respects, on par with global laboratories and, in some cases, even ahead of them. Our approach involves adopting innovative methods, enabling us to utilize the latest diagnostic tests available in the market. We aim to make these tests accessible to the Indian population so that they can readily undergo testing.

IBT: Can you share any insights from your research work related to cardiac biomarkers or laboratory techniques that may be of interest to healthcare professionals and researchers?

Dr. Sohini Sengupta: Currently, as I mentioned earlier, we have just begun utilizing HSTropI and NTproBNP as predictive risk markers. We have already initiated this process and have gathered feedback from asymptomatic patients who have proactively come forward for risk prediction and stratification through these two tests, particularly HStropI and NTproBNP. We now have data regarding their risk levels, distinguishing whether they fall into the low, moderate, or high-risk categories.

Moving forward, as part of our ongoing research, our plan is to reconnect with these individuals, gather more comprehensive medical histories, and gain insights into their cardiac journeys. We aim to determine whether those classified as moderate or high risk have consulted cardiologists, and undergone further cardiac testing and whether any minor cardiac events may have been prevented by their early testing using these predictive risk markers. This is an initiative we have recently embarked upon and intend to develop further.

Additionally, as you may already be aware, RedCliffe has conducted an impact study to assess its contribution to reducing the burden of cardiovascular diseases in the country. This assessment includes our conventional testing, such as diabetic profiles and lipid profiles. We also plan to continue and expand this aspect of our work.”

IBT: In your opinion, what are the most critical steps that need to be taken to reduce the burden of cardiovascular diseases in India and globally, and how can laboratory medicine play a pivotal role in achieving these goals?

Dr. Sohini Sengupta: As I mentioned earlier, the prevalence of cardiovascular diseases is increasing in low and middle-income countries, which collectively account for approximately 80% of the global burden of cardiovascular diseases. Among these countries, mortality rates related to heart diseases are notably high among Asian Indians, with rates 20% to 50% higher than in other populations.

It’s crucial to grasp the significance of risk factors such as diabetes, and hypertension, as well as the sedentary lifestyle, alcohol and tobacco use, and genetic predisposition in this emerging epidemic. We must gain a comprehensive understanding of these risk factors and work effectively towards their control. However, effective control can only be achieved once we have identified individuals at risk. This is where the role of a laboratory becomes vital.

Laboratories play a crucial role in mass population screening through the utilization of risk stratification blood markers. These tests are highly accessible, and easily conducted at home, in laboratory facilities, or even during health camps. The process involves collecting samples, which are then processed in the laboratory, making it a straightforward procedure.

I believe the role of the laboratory becomes crucial in mass population screening, especially given the significant increase in cardiac events among young adults. It’s alarming to see people in their 30s and 40s experiencing cardiac events, a trend that was uncommon before. Therefore, it’s essential to identify and address risk factors early in life. We need to be proactive in screening large populations, identifying those at higher risk, and helping them adopt preventive measures.

These preventive measures may include promoting lifestyle changes, dietary adjustments, and other interventions aimed at preventing or slowing the progression of atherosclerosis, which is the root cause of cardiovascular events. So, the first role of the laboratory is in mass screening and facilitating more preventive health checks. These checks enable individuals to undergo testing and identify potential cardiac risks for the future.

Secondly, the laboratory plays a crucial role in diagnosing individuals who already have underlying cardiac conditions. This includes those who are diabetic, have abnormal lipid profiles, or suffer from hypertension. Early and accurate diagnosis is essential for effective management and treatment of their cardiac diseases.”

The role of the laboratory extends to both prevention through screening and the diagnosis of cardiac events. Furthermore, our focus should not solely be on adulthood. I believe as a community and population, we should also promote early-life interventions to raise awareness about healthy lifestyle practices. This way, as children grow into adulthood, they will inherently be conscious of their choices. As a result, as a community, we will be better prepared to prevent or address this emerging burden. I consider this aspect to be of utmost importance.”

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Dr. Sohini Sengupta is an MD & DNB in Clinical Biochemistry, & FNB in Laboratory Medicine. She is the Medical Laboratory Director for Redcliffe Labs, India. She is a Technical Assessor for the NABL, India (National Accreditation Board for Testing & Calibration Laboratories), and the Corresponding Member from India on various IFCC (International Federation of Clinical Chemistry & Laboratory Medicine) committees.

Dr Sohini was previously associated with Sir Gangaram Hospital, and MAX Healthcare, and has over 15 years of experience in healthcare diagnostics. She is a Green Belt in Six Sigma processes. Dr. Sohini has numerous publications in indexed national and international journals. She has been invited as a speaker to share her academic and scientific work at international conferences and symposia. Her areas of interest include diagnostics in women’s health, metabolic disorders, point-of-care testing, and quality assurance in clinical laboratories.