Indo-Asian Patients Research Articles

The Deadly Triad

The Deadly Triad

Do Indo-Asians have smaller coronary arteries?

There is a widespread belief that coronary arteries are smaller in Indo-Asians. The aim of the present study was to compare the size of atheroma-free proximal and distal epicardial coronary...

Atrial fibrillation amongst the Indo-Asian general practice population: The West Birmingham Atrial Fibrillation Project

Whilst there are recognised ethnic differences in cardiovascular disease, with a higher prevalence of hypertension and complications such as stroke amongst black/Afro–Caribbean populations, and ischaemic heart disease being more prevalent amongst Indo–Asians, the literature describing the clinical epidemiology of atrial fibrillation (AF) in non-caucasian groups is scarce. To survey the clinical features and management amongst Indo–Asian patients with known AF, we studied patients from six general practices in the west of Birmingham. The six general practices had a combined practice population of 25 051, from which, the Indo–Asian population was 14 670. A total of 12 Indo–Asian patients (six male, six female; mean age, 67 years; range, 42 to 95 years) with known AF were identified, suggesting a prevalence of AF in Indo–Asians aged >50 years of 0.6%. Six patients had chronic AF, two had recent onset (defined as onset <six months) and four had paroxysmal AF. Five patients had a history of ischaemic heart disease, three had hypertension, seven had heart failure, two had alcohol excess, four had mitral valve disease, and one patient with paroxysmal AF had sick sinus syndrome. None could be classified as having lone AF. Only four patients were anticoagulated, but, of the remaining eight, who were not taking warfarin, six were taking aspirin. None of the patients had contraindications to warfarin, but one of the patients who was taking aspirin had poor compliance to warfarin. In this survey of a general practice Indo–Asian population of approximately 14 670, we found 12 patients with known AF. More information on the clinical epidemiology of AF in non-caucasian groups is still needed and urgently required, in view of the public health implications of this common cardiac arrhythmia.

Long-term complications in newly diagnosed Sri Lankan patients with type 2 diabetes mellitus.

We screened 597 newly-diagnosed diabetic patients (201 women) mean +/- SD age 42.3 +/- 6.2 years to determine the prevalence of diabetic complications; 22% presented because of symptoms of diabetes, 27% were diagnosed when hyperglycaemia was discovered at a health screening, and 36% were diagnosed while being treated for intercurrent illness. Neuropathy was present in 25.1%, nephropathy in 29%, retinopathy in 15%, coronary vascular disease in 21%, stroke in 5.6%, peripheral vascular disease in 4.8%, hypertension in 23%, obesity in 16%, central obesity in 21.3%, hypercholesterolaemia in 11%, hypertriglyceridaemia in 14%, and low high-density lipoprotein cholesterol in 12%. The prevalence of coronary vascular disease, hypertension, stroke, neuropathy and retinopathy at the time of diagnosis were higher in our patients than in Caucasian and Indo-Asian patients in the UK. Both a genetic predisposition to develop complications, and exposure to a longer duration of asymptomatic hyperglycaemia due to poor access to adequate health care, may contribute to the high frequency of complications at diagnosis. Since complications are already present at diagnosis, there is a case for implementing primary prevention programmes combined with screening for diabetes in high-risk groups.

Rate of decline in renal function in Indo-Asians and Whites with diabetic nephropathy.

The incidence of end-stage renal failure (ESRF) is higher in the Indo-Asian ethnic group as compared to the White. To investigate whether this might be associated with faster rates of progression to ESRF in Indo-Asian diabetic patients, we studied a total of 39 Type 2 diabetic patients, using the Department of Nephrology database showing serial serum creatinine measurements from the time of first referral to the clinic until they reached a level of >500 micromol l(-1) or ESRF requiring renal replacement therapy (RRT), either dialysis or renal transplantation. They were grouped into Indo-Asian (n = 24) and White (n = 15). The rate of progression of those who developed ESRF, calculated as the slope of log serum creatinine against time, was not significantly different between the Indo-Asian and White patients, p = 0.73. We conclude that the higher incidence of ESRF in the Indo-Asian Type 2 diabetic patient with nephropathy is therefore not due to a faster rate of deterioration in renal function.

Ethnic differences in pre-admission levels of physical activity in patients admitted with myocardial infarction

Background: Regular exercise is generally considered to reduce the risk of coronary heart disease. Reduced levels of physical activity in Indo-Asians may partly explain why patients from this ethnic group sustain so many heart attacks. Aim: To investigate ethnic differences in pre-admission levels of physical activity amongst patients admitted with myocardial infarction and triggers for the acute cardiac event. Design: Cross-sectional study using standard Baecke questionnaire, which provided a semi-quantitative work score, sport score, leisure score and total activity score of general daily activities, with additional questions on activity at the onset of chest pain. Setting: Coronary Care Unit, City Centre Teaching Hospital. Patients and results: We studied 100 consecutive patients (76 males, mean age 62.3 years, S.D. 12.5; 74 caucasians, 26 Indo-Asians) admitted with myocardial infarction. Most patients were engaged in sedentary activities, including lying in bed (25%), sitting (19%), watching television (14%) and sleeping (6%), whilst only 21% of patients were engaged in physical activity at chest pain onset; there were, however, no ethnic differences in activity at chest pain onset. There was a diurnal variation in chest pain onset, with the mode between 08:00 and 10:00 h. As the mean age of Indo-Asians was significantly lower than caucasians in the whole group (56.3 vs. 64.4 years; t-test, P < 0.002), the Baecke questionnaire analysis was confined to only male patients aged <70 years ( n = 56). Indo-Asian patients with myocardial infarction were found to have a significantly lower overall physical activity score (3.78 vs. 5.33; P = 0.003), leisure time physical activity (2.43 vs. 2.74; P < 0.05) and sporting score (0.14 vs. 0.82; P < 0.01) when compared to caucasians, despite a similar mean age and body mass index. Conclusion: The majority of myocardial infarction patients were engaged in sedentary activities at chest pain onset. Although there were no differences between caucasians and Indo-Asians in activity at symptom onset, Indo-Asian patients had a significantly lower overall physical activity score, leisure time physical activity and sporting score compared to caucasians. The lower general physical activity amongst Indo-Asians may in part contribute to the high prevalence of ischaemic heart disease amongst this ethnic group.