Cardiovascular risk assessment in South and Middle-East Asians living in the Western countries.

Sahrai Saeed,Peter M Nilsson,Alka M Kanaya,Louise Bennet

doi:10.12669/pjms.36.7.3292

Abstract

Nearly a quarter of the world population lives in the South Asian region (India, Pakistan, Bangladesh, Sri Lanka, Nepal, Bhutan, and the Maldives). Due to rapid demographic and epidemiological transition in these countries, the burden of non-communicable diseases is growing, which is a serious public health concern. Particularly, the prevalence of pre-diabetes, diabetes and atherosclerotic cardiovascular disease (CVD) is increasing. South Asians living in the West have also substantially higher risk of CVD and mortality compared with white Europeans and Americans. Further, as a result of global displacement over the past three decades, Middle-Eastern immigrants now represent the largest group of non-European immigrants in Northern Europe. This vulnerable population has been less studied. Hence, the aim of the present review was to address cardiovascular risk assessment in South Asians (primarily people from India, Pakistan and Bangladesh), and Middle-East Asians living in Western countries compared with whites (Caucasians) and present results from some major intervention studies. A systematic search was conducted in PubMed to identify major cardiovascular health studies of South Asian and Middle-Eastern populations living in the West, relevant for this review. Results indicated an increased risk of CVD. In conclusion, both South Asian and Middle-Eastern populations living in the West carry significantly higher risk of diabetes and CVD compared with native white Europeans. Lifestyle interventions have been shown to have beneficial effects in terms of reduction in the risk of diabetes by increasing insulin sensitivity, weight loss as well as better glycemic and lipid control.

Highlights

The risk of cardiovascular disease (CVD) events differs according to ethnical background
United States (US), has been investigated in a number of observational studies.[9,10,11,12,13,14,15]. These studies show that South Asians living in Western countries have a higher risk of coronary artery disease (CAD), insulin resistance, type 2 diabetes (T2D), metabolic syndrome, hypertension, and dyslipidemia than whites.[8,9,10,11,12,13,14,15]
We have addressed CV risk assessment in South Asians, mainly people from India, Pakistan and Bangladesh living in Western countries, as well as Middle-East Asians living in Scandinavia, compared with white Europeans

Summary

INTRODUCTION

The risk of cardiovascular disease (CVD) events differs according to ethnical background. The use of CAC in the CV risk assessment, and possibly CT angiography, may be relevant for South Asian individuals who are younger and more often have T2D compared with their European and American counterparts, as well as a growing field of research.[8] South Asians and Middle Eastern immigrants in Scandinavia: South Asians in Norway, immigrants from India and Pakistan, have been shown to be prone to T2D, abdominal obesity and other cardiometabolic disorders, which all substantially increase the risk of CVD events.[29,30] it is important to highlight that people from South Asia, and other nonWestern populations such as immigrants from the Middle-East, run a higher risk of obesity, T2D, metabolic syndrome and CAD compared to native white North Europeans.[23] in a large cohort study from Denmark comparing 62,461 nonwestern immigrants with 249,839 native Danes as a reference population (matched individually 1:4 for age and sex), multiple inter-ethnic trends in the risk of CVD were observed.[31] Immigrants from Central Asia, South Asia, Iraq, Turkey, the Middle East and North Africa, Eastern Europe and the Former Yugoslavia all had significantly higher incidences of CAD compared with Danish-born people. Table-I: Harmonized criteria for clinical diagnosis of the metabolic syndrome.[41]

Low HDL cholesterol

Findings

CONCLUSIONS