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
The prevalence of Type 2 Diabetes worldwide was about 2.8% in 2000 and is projected to be 4.4% in 2030[1,2,3]
The total sample consisted of 213 participants; subjects were categorized into two subgroups on the basis of diabetes: 35 diabetics and 178 non diabetics
The entire cohort of SAIS had higher incidence of atherosclerosis as determined by CCAIMT. These findings suggest that South Asian Immigrant Indians (SAIns) immigrants fall in a higher risk category than other population and it may be reasonable to screen these individuals for asymptomatic Coronary Artery Diseases (CAD)
Summary
The prevalence of Type 2 Diabetes (diabetes) worldwide was about 2.8% in 2000 and is projected to be 4.4% in 2030[1,2,3]. Many studies have reported high rates of diabetes and Coronary Artery Diseases (CAD) among South Asian immigrants (SAIs-people from the Indian subcontinent- India, Pakistan, Bangladesh, Sri Lanka, Nepal, Bhutan) worldwide. Studies in the United Kingdom (UK) have found that SAIs’ risk of CAD death is as high as 40% above whites’, and they have a 2- to 4-fold higher incidence of diabetes [2,3,4]. The South Asian Association for Regional Cooperation (SAARC) reported that mortality and morbidity due to diabetes and Cardiovascular Disease (CVD) are higher in expatriate South Asian populations than in any other expatriate ethnic group worldwide [6,7,8]. 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. 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
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