South Asians and coronary heart disease: always bad news?

Abstract

Latest data from the 2001 UK Census noted that, although coronary mortality fell among all migrants, rate ratios for coronary mortality remain higher for men and women of south Asian origin.1 Ethnic inequalities in coronary heart disease (CHD) therefore continue to exist and justify the significant and commendable efforts of the UK's National Health Service (NHS) to address these inequalities. Ethnic disparities in CHD mortality continue to be reported from around the globe. Sheth et al reported on cardiovascular mortality among Canadians of European, south Asian, or Chinese origin from 1979 to 1993.2 In their analysis of 1.2 million deaths, rates of death from ischaemic heart disease were highest among Canadians of south Asian origin, whereas those of Chinese origin had a substantially lower rate. Before we discuss the causes of ethnic disparities in CHD, one must be cognisant of the fact that south Asians are a heterogeneous group and therefore important differences do exist between specific ethnic groups, not only in disease outcomes but also risk factor profiles too. These differences are too extensive to be addressed in this short summary but more detailed accounts are accessible elsewhere.3 It is well known that south Asians have substantially higher rates of diabetes, and this is often the risk factor most blamed for their higher CHD mortality.4 In a prospective cohort study conducted of 828 south Asian and 27 962 non south Asian patients in the UK with insulin-treated diabetes, the standardised mortality ratio for south Asians diagnosed with diabetes before 30 years of age was 3.9 (95% CI = 2.0 to 6.9) in men and 10.1 (95% CI = 5.6 to 16.6) in women; in corresponding non south Asian men and women, the figures were 2.7 (95% CI = 2.6 to …