Abstract
Background: South Asian Immigrants (SAIs) are the second fastest growing Asian immigrant population in the US, and at a higher risk of type 2 diabetes (diabetes) than the general US population. Coronary Artery Disease (CAD) is the principal cause of mortality globally, particularly in diabetic subjects. In this study, we sought to determine the; 1) distribution of risk factors for CAD in diabetic and non-diabetic SAIs; and 2) presence of sub-clinical CAD in diabetic and non diabetic SAIs in the US. Methods: 213 first generation SAIs subjects were recruited and broadly divided into two subgroups; 35 diabetics and 178 non diabetics. Their risk factors for CAD were compared. For sub-clinical CAD assessment, Common Carotid Artery Intima-Media Thickness (CCA-IMT) was used as a surrogate marker for atherosclerosis. For CAD diagnosis, Exercise Tolerance stress Test (ETT) was performed. Results: Both diabetics and non diabetics SAIs in general, share a very heavy burden of CAD risk factors. Hypertension (p=0.003), high cholesterol (p<0.0001) and family history of diabetes (p<0.0001) was significantly associated with diabetes. Presence of sub-clinical CAD was also higher in diabetics as compared to non diabetics (63% Vs 52%). 45% of diabetics (who were not previously diagnosed with CAD) were found to be ETT positive for CAD (p<0.0001). Conclusion: CAD risk factors and sub-clinical CAD are more prevalent amongst diabetic SAIs. Early screening and aggressive treatment for risk factor reduction in SAIs is the key to combating the increasing incidence of CAD. Larger prospective trials are required to confirm these study findings.
Highlights
With the significant increase in the number of racial/ethnic minority youth with obesity and type 2 diabetes mellitus (T2DM), effective approaches are urgently needed
Previous school-based studies have demonstrated that programs combining environmental, behavioral and educational components can be successful in preventing cardiovascular disease in youth [1,2] such studies have not focused on youth at higher risk for T2DM in inner-city, racial/ethnic minority youth
School-based obesity prevention programs are most effective if they follow a coordinated, comprehensive program for school health (CSHP) that combines dietary guidelines, physical activity and school-based or environmental activities [16]. These findings suggest the promise of comprehensive interventions, while highlighting the need for innovative approaches for youth at risk for T2DM, Latino youth who may be at the highest risk due to the high rates of obesity in this population [17]
Summary
With the significant increase in the number of racial/ethnic minority youth with obesity and type 2 diabetes mellitus (T2DM), effective approaches are urgently needed. Previous school-based studies have demonstrated that programs combining environmental, behavioral and educational components can be successful in preventing cardiovascular disease in youth [1,2] such studies have not focused on youth at higher risk for T2DM in inner-city, racial/ethnic minority youth. Studies suggest that the greatest decrease in physical activities occurs during early to late adolescence, a critical period of child growth and development. This decrease correlates with the increasing number of youth who are overweight (Body Mass Index [BMI] ≥ 84th - 94th percentile) or obese (BMI ≥ 95th percentile) [3]. Recent estimates from a population-based study suggest high rates of racial/ ethnic disparities, with higher prevalence seen in African-American youth (3.22 cases per 1000 youth) and Latino youth
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