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• Response regarding the PAK-SEHAT Longitudinal Study on Premature Coronary Atherosclerosis
  Zunaira Kiran, Umaimah Batool Mirza and Imteshal Sarfaraz
  Published on: 13 May 2025

• Published on: 13 May 2025

  Response regarding the PAK-SEHAT Longitudinal Study on Premature Coronary Atherosclerosis

  • Zunaira Kiran, Student Sindh Medical College
  • Other Contributors:
    • Umaimah Batool Mirza, Doctor
    • Imteshal Sarfaraz, Student

  The study protocol by Zaman et al describes PAK-SEHAT as the research initiative for investigating premature atherosclerotic cardiovascular disease (ASCVD) in Pakistan. The research targets an important knowledge gap in cardiovascular healthcare research for South Asia because its CVD prevalence continues to increase in populations with low-to-middle income status.

  Several comments arise from our reading of the research. The research identifies “young adults” as very mature males who are younger than 60 and very mature females who are younger than 65 years but this definition goes beyond the typical age range of 18–44 years [1]. The expanded population inclusion might dim the line separating early and conventional ASCVD manifestation.

  CCTA along with CIMT serves as an effective method to detect subclinical plaques in patients [2]. These expensive diagnostic tests represent a major barrier that affects the system-wide implementation of public health screening and intervention programs in Pakistan.

  Excluding participants with BMI higher than 40 kg/m² or eGFR lower than 60 ml/min/1.73m² may unintentionally exclude persons at high risk from the study. People with South Asian origins who have metabolic syndrome or renal impairment tend to develop ASCVD at an earlier stage according to research [3] and their removal from the study might diminish the application of study findings to wider populations.

  The protocol states it will recruit nationally in P...

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  The study protocol by Zaman et al describes PAK-SEHAT as the research initiative for investigating premature atherosclerotic cardiovascular disease (ASCVD) in Pakistan. The research targets an important knowledge gap in cardiovascular healthcare research for South Asia because its CVD prevalence continues to increase in populations with low-to-middle income status.

  Several comments arise from our reading of the research. The research identifies “young adults” as very mature males who are younger than 60 and very mature females who are younger than 65 years but this definition goes beyond the typical age range of 18–44 years [1]. The expanded population inclusion might dim the line separating early and conventional ASCVD manifestation.

  CCTA along with CIMT serves as an effective method to detect subclinical plaques in patients [2]. These expensive diagnostic tests represent a major barrier that affects the system-wide implementation of public health screening and intervention programs in Pakistan.

  Excluding participants with BMI higher than 40 kg/m² or eGFR lower than 60 ml/min/1.73m² may unintentionally exclude persons at high risk from the study. People with South Asian origins who have metabolic syndrome or renal impairment tend to develop ASCVD at an earlier stage according to research [3] and their removal from the study might diminish the application of study findings to wider populations.

  The protocol states it will recruit nationally in Pakistan although it fails to clarify appropriate representation of every province and ethnic groups and socioeconomic backgrounds. The study requires clarification about population sampling across different regions since cardiovascular health risks differ between areas [4]. This information helps prevent vital subgroup differences from being neglected.

  The research depends on single-site data collection and industrial sponsorship which creates issues about research diffusion across diverse settings and possible funding-related biases. Research in public health achieves its best outcomes when an independent assessment maintains strong transparency standards and preserves public trust [5].

  The PAK-SEHAT initiative holds great importance to us so we look forward to seeing how our proposals can improve both its application and its impact.,
  Sincerely,
  Zunaira Kiran, Umaimah Mirza, Imteshal Sarfaraz

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  Conflict of Interest:
  None declared.

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