South Asians with diabetes mellitus do not receive lipid-lowering treatment despite an identical calculated risk of coronary heart disease compared with Caucasians

Abstract

We have evaluated the effect of a computerised CHD risk calculation program, based on the Framingham algorithm, on the use of cholesterol-lowering agents in a hospital diabetes clinic. For a period of six months we audited the appropriateness of the original request for CHD risk calculation, the clinical action taken and the outcome for all patients with a calculated 10 year CHD risk ≥30%. CHD risk calculations were performed on 1264 patients, of whom 180 (14.2%) had calculated 10 year CHD risks ≥30%. The case notes were available on 128 (71.1%) of these patients of whom 38 (30%) were of South Asian ethnicity. 47 patients (37%) had CHD risk calculations performed inappropriately, primarily due to pre-existing cardiovascular disease. There were no significant racial differences in calculated CHD risk, systolic blood pressure, cholesterol/HDL ratio, prevalence of current cigarette smoking or left ventricular hypertrophy in the remaining 81 patients. The South Asian group had significantly lower total and HDL cholesterol levels (p=0.001 and 0.004 versus Caucasians). Statins were prescribed in 49 patients (60.5%) (15/31 Asians versus 34/50 Caucasians; p=0.064). Those patients without pre-existing cardiovascular disease but who have calculated 10 year CHD risks ≥30% should be candidates for cholesterol-lowering drugs. South Asians appear less likely to receive such treatment, possibly because they have on average lower total serum cholesterol concentrations than do Caucasian patients at identical levels of calculated CHD risk. During the audit, 3/31 South Asians and 2/50 Caucasians had a first non-fatal myocardial infarct (p=0.28, Fisher exact probability). Copyright © 2000 John Wiley & Sons, Ltd.