TITLE: Cardiovascular and cancer mortality among Canadians of European, south Asian and Chinese origin from 1979 to 1993: an analysis of 1.2 million deaths.
AUTHOR: Sheth T, Nair C, Nargundkar M, Anand S, Yusuf S
AFFILIATION: Division of Cardiology, Hamilton Civic Hospitals Research Centre, McMaster University, Ont., Canada.
SOURCE: CMAJ 1999 Jul 27;161(2):132-8
ABSTRACT: BACKGROUND: Cardiovascular disease and cancer are important health problems worldwide, yet our knowledge of these conditions is derived principally from populations of European descent. To investigate ethnic variations in major causes of death in Canada, the authors examined total and cause-specific mortality among European, south Asian, and Chinese Canadians. METHODS: Canadians of European, south Asian and Chinese origin were identified in the Canadian Mortality Database by last name and country of birth and in the population census by self-reported ethnicity. Age-standardized death rates by cause, per 100,000 population, were calculated for ages 35 to 74 years from 1979 to 1993 and in 5-year intervals grouped around census years (1979/83, 1984/88 and 1989/93). RESULTS: Rates of death from ischemic heart disease were highest among Canadians of south Asian origin (men 320.2, women 144.5) and European origin (men 319.6, women 109.9) and were markedly lower among Canadians of Chinese origin (men 107.0, women 40.0); the rates declined significantly in all 3 groups over the study period. Rates of death from cerebrovascular disease were relatively low and showed less ethnic variation (Canadian men of European, south Asian and Chinese origin 49.5, 47.0 and 45.8 respectively; Canadian women of European, south Asian and Chinese origin 34.8, 39.0 and 42.2 respectively) and declined similarly in all groups over time. Rates of death from cancer were highest among Canadians of European origin (men 343.6, women 236.2), intermediate among those of Chinese origin (men 258.1, women 161.6) and lowest among those of south Asian origin (men 122.3, women 131.3). Over time, cancer mortality increased in Canadians of European origin but remained constant or declined in those of south Asian and Chinese origin. INTERPRETATION: Substantial differences exist in rates of death from ischemic heart disease and cancer among European, south Asian and Chinese Canadians.
TITLE: Plasma vitamin C levels in men and women from different ethnic backgrounds living in England.
AUTHOR: Ness AR, Cappuccio FP, Atkinson RW, Khaw KT, Cook DG
AFFILIATION: Department of Social Medicine, University of Bristol, UK.
SOURCE: Int J Epidemiol 1999 Jun;28(3):450-5
ABSTRACT: BACKGROUND: People of South Asian origin living in the UK have higher death rates due to coronary heart disease than whites. The reasons for these differences are not fully understood. Previous attempts to relate diet to cardiovascular risk in South Asians have been inconclusive. METHODS: We compared the levels of plasma vitamin C in a cross-sectional population-based study of 1018 men and women aged 40-59 (455 men, 563 women, 328 South Asians, 355 of African descent, 335 whites) co-resident in a geographically defined area of South London, when allowing for potential confounders. RESULTS: Fasting plasma vitamin C levels were significantly higher in women, vegetarians, supplement takers and non-smokers. After adjustment for age, body mass index, current smoking, supplement use and vegetarianism the mean plasma vitamin C levels were 38.8 (SE 1.6) mumol/l in white men, 36.5 (1.6) mumol/l in men of African descent and 32.9 (1.5) mumol/l in South Asian men (P = 0.033 by analysis of co-variance). In women the adjusted mean plasma vitamin C levels were 52.4 (1.6) mumol/l in whites, 46.0 (1.4) mumol/l in women of African descent and 37.3 (1.8) mumol/l in South Asians (P < 0.0001 by analysis of covariance). South Asians had lower levels than whites in both men (difference 6.4 [95% CI: 1.5, 11.3] mumol/l) and women (16.8 [95% CI: 11.5, 22.1] mumol/l). South Asian women, but not men, also had lower levels than those of African descent (8.8 [95% CI: 4.5, 13.1] mumol/l). African women, but not men, had lower levels than white women (6.6 [95% CI: 2.3, 10.9] mumol/l). No significant differences were seen between Caribbeans and West Africans or between South Asian Hindus and Muslims. CONCLUSIONS: These data suggest that important dietary differences in vitamin C exist between different ethnic groups living in England. The larger differences in South Asians may contribute to their increased coronary risk. PMID: 10405847, UI: 99334319
TITLE: Serum sialic acid, a reputed cardiovascular risk factor, is elevated in South Asian men compared to European men.
AUTHOR: Crook M, Kerai P, Andrews V, Lumb P, Swaminathan R
AFFILIATION: Department of Chemical Pathology, Guy's and St Thomas' Hospital, London, UK.
SOURCE: Ann Clin Biochem 1998 Mar;35 ( Pt 2):242-4
ABSTRACT: Serum total sialic acid (TSA) has recently been reported as a cardiovascular risk factor, but whether there are racial differences is not known. One hundred and twenty-four healthy young subjects (62 women and 62 men) were studied. Their age was 20.7 [0.9] years and they were matched for body mass index (BMI). Sixty-eight were of South Asian origin (37 women and 31 men) and 56 (25 women and 31 men) were European. Mean (SD) serum TSA was significantly higher in the South Asian men than the age-matched European men (74.3 [12.3] mg/dL versus 68.2 [13.0] mg/dL, P = 0.0198). In addition, serum TSA was significantly higher in South Asian women compared with European men (71.6 [8.9] mg/dL versus 68.2 [13.0] mg/dL, P = 0.0352). Finally, serum TSA was significantly higher in European women compared with European men (76.0 [13.1] mg/dL versus 69.2 [13.0] mg/dL, P = 0.008). We conclude that serum TSA may be worth measuring in different racial groups and also may be useful to assess individuals at risk of cardiovascular disease. Large prospective studies may help to explain why serum TSA is a reputed cardiovascular risk factor and shows racial differences.
TITLE: Prevalence, detection, and management of cardiovascular risk factors in different ethnic groups in south London.
AUTHOR: Cappuccio FP, Cook DG, Atkinson RW, Strazzullo P
AFFILIATION: Department of Medicine, St George's Hospital Medical School, London, UK. firstname.lastname@example.org
SOURCE: Heart 1997 Dec;78(6):555-63
ABSTRACT: OBJECTIVE: To assess the prevalence of cardiovascular risk factors and their level of detection and management in three ethnic groups. DESIGN: Population based survey during 1994 to 1996. SETTING: Former Wandsworth Health Authority in South London. SUBJECTS: 1578 men and women, aged 40 to 59 years; 524 white, 549 of African descent, and 505 of South Asian origin. MAIN OUTCOME MEASURES: Age adjusted prevalence of hypertension, diabetes, obesity, raised serum cholesterol, and smoking. RESULTS: Ethnic minorities of both sexes had raised prevalence rates of hypertension and diabetes compared to white people. Age and sex standardised prevalence ratios for hypertension were 2.6 (95% confidence interval 2.1 to 3.2) in people of African descent and 1.8 (1.4 to 2.3) in those of South Asian origin. For diabetes, the ratios were 2.7 (1.8 to 4.0) in people of African descent and 3.8 (2.6 to 5.6) in those of South Asian origin. Hypertension and diabetes were equally common among Caribbeans and West Africans and among South Asian Hindus and Muslims. Prevalence of severe obesity was high overall, but particularly among women of African descent (40% (35% to 45%)). In contrast, raised serum cholesterol and smoking rates were higher among white people. Of hypertensives, 49% (216 of 442) had adequate blood pressure control. Overall, 18% (80 of 442) of hypertensives and 33% (62 of 188) of diabetics were undetected before our survey. Hypertensive subjects of African descent appeared more likely to have been detected (p = 0.034) but less likely to be adequately managed (p = 0.085). CONCLUSIONS: Hypertension and diabetes are raised two- to threefold in South Asians, Caribbeans, and West Africans in Britain. Detection, management, and control of hypertension has improved, but there are still differences between ethnic groups. Obesity is above the Health of the Nation targets in all ethnic groups, particularly in women of African descent. Preventive and treatment strategies for different ethnic groups in Britain need to consider both cultural differences and underlying susceptibility to different vascular diseases.
TITLE: Comparison of methods to assess coronary heart disease prevalence in South Asians.
AUTHOR: Patel DJ, Winterbotham M, Sutherland SE, Britt RG, Keil JE, Sutton GC
AFFILIATION: Department of Cardiology, Hillingdon Hospital, Uxbridge, Middlesex, United Kingdom.
SOURCE: Natl Med J India 1997 Sep-Oct;10(5):210-3
ABSTRACT: BACKGROUND: Migrants from the Indian subcontinent (South Asian migrants) in the United Kingdom have high mortality from coronary heart disease (CHD) in comparison to the indigenous population. Few studies have assessed the prevalence of CHD in South Asians, and the applicability of conventional survey methods in this population is not known. In this pilot random population survey of South Asian men and women living in West London, the prevalence of CHD as judged by the Rose questionnaire, past cardiac history, cardiologist and resting electrocardiogram were compared. METHODS: Subjects aged 30-64 years from randomly selected households were invited for a cardiological assessment. A lay person administered the Rose questionnaire and recorded the past cardiac history. A cardiologist also made an independent assessment and a 12-lead electrocardiogram was recorded and analysed according to the Minnesota code. RESULTS: Three hundred and seventy-six individuals (192 men and 184 women) were assessed. The prevalence of angina in men and women, respectively, was 3.1% and 4.9% by the Rose questionnaire; 2.6% and 2.2% by past cardiac history; and 4.2% and 0.5% according to the cardiologist. The prevalence of myocardial infarction in men and women, respectively, was 5.2% and 2.2% by the Rose questionnaire, 3.6% and zero by past cardiac history and 3.6% and 0.5% by the cardiologist. Q/QS codes were present in 1.6% men and 0.5% women and ischaemic codes in 13% men and 14% women. Ischaemic changes were not associated with any cardiac history in 72% of men and 92% of women. For a diagnosis of CHD in men, there was poor agreement between the Rose questionnaire and either the past cardiac history or the cardiologist's assessment, but moderate agreement between the past cardiac history and the cardiologist. Agreement was poor between all three methods for a positive diagnosis of CHD in women. CONCLUSION: Current accepted epidemiological methods for assessing CHD prevalence may be inaccurate in South Asians, especially women. Electrocardiogram abnormalities suggestive of ischaemia are common in South Asians and are usually not associated with evidence of CHD. Thus, their value as indicators of CHD is questionable.
TITLE: Lay diagnosis and health-care-seeking behaviour for chest pain in south Asians and Europeans.
AUTHOR: Chaturvedi N, Rai H, Ben-Shlomo Y
AFFILIATION: EURODIAB, Department of Epidemiology and Public Health, University College London, UK.
SOURCE: Lancet 1997 Nov 29;350(9091):1578-83
ABSTRACT: BACKGROUND: South Asian people in the UK experience greater delays than Europeans in obtaining appropriate specialist management for heart disease, but the causes are not known. We investigated whether south Asians and Europeans interpret and act upon anginal symptoms differently. METHODS: We randomly selected 2000 people from general practitioners' (family physicians) lists in London, UK, to receive a questionnaire that included a short fictional case history of an individual with possible anginal pain and asked how respondents would react to experiencing it. A second questionnaire seeking information on medical history, attitudes to health, and demography was sent later. The main outcome measure was the proportion who said they would seek immediate care (hospital emergency department or general practitioner) for the pain described in the case scenario. FINDINGS: The rate of response to both questionnaires was 60.2% (903 of 1500 who received both), 553 responders were of European origin, 124 were Hindu, and 235 were Sikh. There were no differences between the ethnic groups in the proportion identifying the pain as cardiac, but south Asians would be more anxious about the pain than would Europeans. Of the men, 55 (23%) Europeans, 20 (38%) Hindus, and 52 (47%) Sikhs said they would seek immediate care (p < 0.0001 for heterogeneity); of women, 77 (24%), 25 (35%), and 58 (46%), respectively, would seek immediate care (p < 0.0001). After adjustment for confounding variables the odds ratio for seeking immediate care in Hindus compared with Europeans was 2.67 (95% CI 1.49-4.73) and that for Sikhs compared with Europeans was 3.18 (1.98-5.12). INTERPRETATION: Hindus and Sikhs reported a greater likelihood of seeking immediate care for anginal symptoms than Europeans; this finding indicates that barriers to cardiology services for south Asians are unrelated to difficulties in interpretations of symptoms or willingness to seek care. Improvement of awareness of heart disease may not decrease delays in obtaining care. Service-related explanations must be explored, such as general practitioners' difficulties in arriving at a diagnosis or differences in management because of ethnic origin.
TITLE: Ethnic differences in mortality from cardiovascular disease in the UK: do they persist in people with diabetes?
AUTHOR: Chaturvedi N, Fuller JH
AFFILIATION: Department of Epidemiology and Public Health, University College London.
SOURCE: J Epidemiol Community Health 1996 Apr;50(2):137-9
ABSTRACT: STUDY OBJECTIVE: To determine whether ethnic differences in cardiovascular disease mortality persist in people with non-insulin-dependent diabetes mellitus. DESIGN: This was an ecological study in which routine mortality data from 1985-86, which coded all mentioned causes of death, provided the numerator. The UK population derived from 1981 census formed the denominator. SETTING: United Kingdom. PARTICIPANTS: Records of all deaths in people aged 45 years and above were extracted if diabetes was mentioned anywhere on the death certificate. The denominator was aged five years to approximate to the 1986 population. Mortality rates where a cardiovascular underlying cause was given were compared between South Asians, African-Caribbeans, and those born in England and Wales. The latter group formed the standard for directly standardised rate ratios. MAIN RESULTS: Mortality from heart disease was approximately three times higher in diabetic South Asian born men and women than in those with diabetes born in England and Wales. This ethnic difference was greatest in the younger age group. Conversely, stroke mortality rates in African-Caribbeans were 3.5-4 times higher than those in the England and Wales population. Despite this high mortality from stroke, ischaemic heart disease death rates were not high in African-Caribbean men. CONCLUSIONS: Ethnic differences in cardiovascular mortality persisted and were greater in those with diabetes. Thus the high risk of heart disease should be targeted for intervention in South Asians, and the high rates of stroke targeted in African-Caribbeans.
TITLE: Racial variation of factor VII activity and antigen levels and their correlates in healthy Chinese and Indians at low and high risk for coronary artery disease.
AUTHOR: Saha N, Heng CK, Mozoomdar BP, Reuben EM, Soh HT, Low PS, Tay JS, Liu Y, Hong S
AFFILIATION: Department of Paediatrics, National University of Singapore, Singapore.
SOURCE: Atherosclerosis 1995 Sep;117(1):33-42
ABSTRACT: Plasma factor VII activity (FVIIc) is one of the independent risk factors of coronary artery disease (CAD) and is controlled by both genetic and environmental factors. South Asians including Indians have one of the highest prevalence and mortality rates from CAD while the Chinese have a much lower risk. Generally accepted risk factors cannot explain the high mortality from CAD in Indians. We examined two hundred and seventy seven Chinese (124 m, 153 f); and 216 healthy Indian (150 m, 66 f) adults for serum lipids; plasma FVIIc and FVIIag levels in order to examine racial variations of these and their correlates in these two populations. Both Indian men and women had significantly higher FVIIc levels (12% and 11%, respectively) than the Chinese even after adjustments of age, BMI and lipids (P < 0.01). In contrast, Indians had significantly lower plasma FVIIag levels than Chinese (8% and 9%, respectively in men and women; P < 0.01). Multiple linear regression analysis shows a strong correlation of FVIIc with serum triglycerides accounting for 4-8% of the total variability of FVIIc in different groups. Further, there was a stronger correlation between FVIIc and FVIIag in Indians than that in the Chinese (0.43 vs. 25) suggesting a greater activation resulting in higher FVIIc in Indians inspite of lower FVIIag levels. The higher FVIIc and stronger activation by triglycerides observed in this study partly explain the higher risk of CAD in Indians.
TITLE: Coronary risk in a British Punjabi population: comparative profile of non-biochemical factors.
AUTHOR: Williams R, Bhopal R, Hunt K
AFFILIATION: MRC Medical Sociology Unit, Glasgow, UK.
SOURCE: Int J Epidemiol 1994 Feb;23(1):28-37
ABSTRACT: OBJECTIVES. To develop a profile of non-biochemical coronary risks for the South Asian population (predominantly Punjabi with origins in the Indian subcontinent) and the general population in Glasgow, with a focus on dietary patterns, and potential causes of stress. DESIGN. Cross-sectional survey of South Asian men and women of 30-40 years (mean 35), compared with a general population sample aged 35 years. MEASUREMENTS. Data were collected on socioeconomic circumstances, smoking, diet, alcohol, exercise, past health, perceptions of stress and other psychological morbidity, blood pressure, height, weight and waist and hip girth. RESULTS. The socioeconomic circumstances of the South Asian group were worse than the general population. The prevalence of several circumstances potentially associated with stress, such as length of working day, low income, crowded housing, liability to attack and perceived lack of social support (women), was greater in South Asians. Smoking was less common in South Asians, particularly among women and non-Muslims. Amongst South Asians, alcohol use was uncommon in women and Muslims. South Asians ate meat, and fruit, salad and raw vegetables more frequently than the general population though there were large variations by religion. South Asian men were less likely to take vigorous exercise than the general population. Diastolic, but not systolic, blood pressure was higher in South Asian males than general population males, but there were no differences among women. Men were shorter and weighed less than general population men, with no difference in body mass index. South Asian women were shorter but had higher mean body mass index than the general population. Waist and hip circumference in both South Asian men and women were higher although waist/hip ratios were not different. Self-reported diabetes was commoner in Asian men than in general population men, and angina symptoms commoner in South Asian women. CONCLUSIONS. Among established risk factors studied here or reported in an earlier paper the only one to which South Asians had less exposure was smoking. In either men or women (or both) there was a relative excess of the other known risk factors. There was evidence in support of three newer hypotheses for the high incidence of coronary heart disease (CHD), namely, insulin resistance, stress, and socioeconomic deprivation. The high CHD rates in South Asians are likely to result from a complex interaction of risk factors.
TITLE: Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians.
AUTHOR: McKeigue PM, Shah B, Marmot MG
AFFILIATION: Department of Community Medicine, University College and Middlesex School of Medicine, London, UK.
SOURCE: Lancet 1991 Feb 16;337(8738):382-6
ABSTRACT: The hypothesis that the high mortality from coronary heart disease (CHD) in South Asians settled overseas compared with other populations is due to metabolic disturbances related to insulin resistance was tested in a population survey of 3193 men and 561 women aged 40-69 years in London, UK. The sample was assembled from industrial workforces and general practitioners' lists. In comparison with the European group, the South Asian group had a higher prevalence of diabetes (19% vs 4%), higher blood pressures, higher fasting and post-glucose serum insulin concentrations, higher plasma triglyceride, and lower HDL cholesterol concentrations. Mean waist-hip girth ratios and trunk skinfolds were higher in the South Asian than in the European group. Within each ethnic group waist-hip ratio was correlated with glucose intolerance, insulin, blood pressure, and triglyceride. These results confirm the existence of an insulin resistance syndrome, prevalent in South Asian populations and associated with a pronounced tendency to central obesity in this group. Control of obesity and greater physical activity offer the best chances for prevention of diabetes and CHD in South Asian people.
TITLE: Diabetes, hyperinsulinaemia, and coronary risk factors in Bangladeshis in east London.
AUTHOR: McKeigue PM, Marmot MG, Syndercombe Court YD, Cottier DE, Rahman S, Riemersma RA
AFFILIATION: Department of Community Medicine, University College and Middlesex School of Medicine, London.
SOURCE: Br Heart J 1988 Nov;60(5):390-6
ABSTRACT: Immigrants from the Indian subcontinent (South Asians) in England and Wales have higher morbidity and mortality from coronary heart disease than the general population; this seems to apply to both Hindus and Muslims. Studies in north west London and Trinidad found that the increased risk of coronary heart disease in Indians was not explained by dietary fat intakes, smoking, blood pressure, or plasma lipids. In the present study the distribution of coronary risk factors was measured in an East London borough where the mortality and attack rate from coronary heart disease are higher in the Asian population, predominantly Muslims from Bangladesh, than in the rest of the population. In a sample of 253 men and women aged 35-69 from general practice, mean plasma cholesterol concentrations were lower in Bangladeshi than in European men and women. Mean systolic blood pressures were 10 mm Hg lower in Bangladeshis. Plasma fibrinogen concentrations were similar in Bangladeshis and Europeans and factor VII coagulant activity was lower in Bangladeshi than in European men. In contrast with the findings in Hindus in north west London, smoking rates were high in Bangladeshi men and the ratio of polyunsaturated fatty acids to saturated fatty acids in plasma lipids was lower in Bangladeshis than in Europeans. Diabetes was three times more common in Bangladeshis than in Europeans and serum insulin concentrations measured after a glucose load were twice as high in Bangladeshis. High insulin concentrations in Bangladeshis were associated with high plasma triglyceride and low high-density lipoprotein cholesterol concentrations.
TITLE: Heterogeneity of coronary heart disease risk factors in Indian, Pakistani, Bangladeshi, and European origin populations: cross sectional study.
AUTHOR: Bhopal R, Unwin N, White M, Yallop J, Walker L, Alberti KG, Harland J, Patel S, Ahmad N, Turner C, Watson B, Kaur D, Kulkarni A, Laker M, Tavridou A
AFFILIATION: Department of Epidemiology and Public Health, Medical School, University of Newcastle, Newcastle upon Tyne NE2 4HH.
SOURCE: BMJ 1999 Jul 24;319(7204):215-20
ABSTRACT: OBJECTIVE: To compare coronary risk factors and disease prevalence among Indians, Pakistanis, and Bangladeshis, and in all South Asians (these three groups together) with Europeans. DESIGN: Cross sectional survey. SETTING: Newcastle upon Tyne. PARTICIPANTS: 259 Indian, 305 Pakistani, 120 Bangladeshi, and 825 European men and women aged 25-74 years. MAIN OUTCOME MEASURES: Social and economic circumstances, lifestyle, self reported symptoms and diseases, blood pressure, electrocardiogram, and anthropometric, haematological, and biochemical measurements. RESULTS: There were differences in social and economic circumstances, lifestyles, anthropometric measures and disease both between Indians, Pakistanis, and Bangladeshis and between all South Asians and Europeans. Bangladeshis and Pakistanis were the poorest groups. For most risk factors, the Bangladeshis (particularly men) fared the worst: smoking was most common (57%) in that group, and Bangladeshis had the highest concentrations of triglycerides (2.04 mmol/l) and fasting blood glucose (6.6 mmol/l) and the lowest concentration of high density lipoprotein cholesterol (0.97 mmol/l). Blood pressure, however, was lowest in Bangladeshis. Bangladeshis were the shortest (men 164 cm tall v 170 cm for Indians and 174 cm for Europeans). A higher proportion of Pakistani and Bangladeshi men had diabetes (22.4% and 26.6% respectively) than Indians (15.2%). Comparisons of all South Asians with Europeans hid some important differences, but South Asians were still disadvantaged in a wide range of risk factors. Findings in women were similar. CONCLUSION: Risk of coronary heart disease is not uniform among South Asians, and there are important differences between Indians, Pakistanis, and Bangladeshis for many coronary risk factors. The belief that, except for insulin resistance, South Asians have lower levels of coronary risk factors than Europeans is incorrect, and may have arisen from combining ethnic subgroups and examining a narrow range of factors.
TITLE: Cardiovascular disease risk factors in 2 distinct ethnic groups: Indian and Pakistani compared with American premenopausal women.
AUTHOR: Kamath SK, Hussain EA, Amin D, Mortillaro E, West B, Peterson CT, Aryee F, Murillo G, Alekel DL
AFFILIATION: College of Health and Human Development Sciences, University of Illinois at Chicago, 60612, USA. email@example.com
SOURCE: Am J Clin Nutr 1999 Apr;69(4):621-31
ABSTRACT: BACKGROUND: Although people from the Indian subcontinent have high rates of cardiovascular disease (CVD), studies of such in Indian and Pakistani women living in the United States are lacking. OBJECTIVE: This study accounted for variability in serum lipid (total cholesterol and triacylglycerol) and lipoprotein [LDL cholesterol, lipoprotein(a), and HDL cholesterol] concentrations in Indian and Pakistani compared with American premenopausal women in the United States. Body composition, regional fat distribution, dietary intake, and energy expenditure were compared between groups. DESIGN: The 2 groups were 47 Indian and Pakistani and 47 American women. Health was assessed via medical history, physical activity, body composition (via anthropometry and dual-energy X-ray absorptiometry), dietary intake (via 7-d food records), and serum lipids. RESULTS: Serum total cholesterol, triacylglycerol, LDL cholesterol, lipoprotein(a), the ratio of total to HDL cholesterol, and the ratio of LDL to HDL cholesterol were greater (P < 0.03), whereas HDL-cholesterol values were lower (P = 0.011) in Indians and Pakistanis than in Americans. Multiple regression analysis indicated that approximately 18% of the variance in total cholesterol (P = 0.0010) and LDL cholesterol (P = 0.0009) was accounted for by ethnicity, energy expenditure, and the ratio of the sum of central to the sum of peripheral skinfold thicknesses. Ethnicity, sum of central skinfold thicknesses, ratio of polyunsaturated to saturated fat, and monounsaturated fat intake accounted for approximately 43% of the variance in triacylglycerol concentration (P < 0.0001). Monounsaturated fat, percentage body fat, and alcohol intake accounted for approximately 26% of variance in HDL cholesterol. Ethnicity contributed approximately 22% of the 25% overall variance in lipoprotein(a). CONCLUSIONS: Results suggest that these Indian and Pakistani women are at higher CVD risk than their American counterparts, but that increasing their physical activity is likely to decrease overall and regional adiposity, thereby improving their serum lipid profiles.
TITLE: Serum cholesterol and coronary artery disease in populations with low cholesterol levels: the Indian paradox.
AUTHOR: Singh RB, Rastogi V, Niaz MA, Ghosh S, Sy RG, Janus ED
AFFILIATION: Heart Research Laboratory and Centre of Nutrition, Medical Hospital and Research Centre, Moradabad, India.
SOURCE: Int J Cardiol 1998 Jun 1;65(1):81-90
ABSTRACT: OBJECTIVE: To examine the relation between serum cholesterol and coronary artery disease prevalence below the range of cholesterol values generally observed in developed countries. DESIGN AND SETTING: Cross-sectional survey of two randomly selected villages from Moradabad district and 20 randomly selected streets in the city of Moradabad. SUBJECTS AND METHODS: 3575 Indians, aged 25-64 years including 1769 rural (894 men, 875 women) and 1806 urban (904 men, 902 women) subjects. The survey methods were questionnaires, physical examination and electrocardiography. RESULTS: The overall prevalences of coronary artery disease were 9.0% in urban and 3.3% in rural subjects and the prevalences were significantly (P < 0.001) higher in men compared to women in both urban (11.0 vs. 6.9%) and rural subjects (3.9 vs. 2.6%). The average serum cholesterol concentrations were 4.91 mmol/l in urban and 4.22 mmol/l in rural subjects without any sex differences. The prevalences of coronary artery disease were significantly higher among subjects with low and high serum cholesterol concentration compared to subjects with very low cholesterol and showed a positive relation with serum cholesterol within the range of serum cholesterol level studied in both rural and urban in both sexes. Among subjects with low serum cholesterol, there was a higher prevalence of coronary risk factors, hypertension, diabetes, obesity and sedentary lifestyle. Serum cholesterol level showed a significant positive relation with low density lipoprotein cholesterol and triglycerides in all the four subgroups. Logistic regression analysis after pooling of data from both rural and urban, with adjustment of age showed that low serum cholesterol level (odds ratio: men 0.96, women 0.91) had a positive strong relation with coronary artery disease and there was no evidence of any threshold. Diabetes mellitus (men 0.73, women 0.74) and sedentary lifestyle (men 0.86, women 0.74) were significant risk factors of coronary disease in both sexes. Hypertension (men 0.82, women 0.64) and smoking (men 0.81, women 0.52) were weakly associated with coronary disease in men but not in women. CONCLUSION: Serum cholesterol level was directly related to prevalence of coronary artery disease even in those with low cholesterol concentration (< 5.18 mmol/l). It is possible that some Indian populations may benefit by increased physical activity and decline in serum cholesterol below the range of desired serum cholesterol in developed countries.
TITLE: Social class and coronary artery disease in a urban population of North India in the Indian Lifestyle and Heart Study.
AUTHOR: Singh RB, Niaz MA, Thakur AS, Janus ED, Moshiri M
AFFILIATION: Centre of Nutrition, Medical Hospital and Research Centre, Moradabad-10, India.
SOURCE: Int J Cardiol 1998 Apr 1;64(2):195-203
ABSTRACT: OBJECTIVE: To determine the association of social class with prevalence of coronary risk factors and coronary artery disease (CAD). DESIGN AND SETTING: Total community cross sectional survey of 20 randomly selected streets in the city of Moradabad. SUBJECTS AND METHODS: 1806 urban (904 men and 902 women) randomly selected subjects aged 25-64 years. The survey methods were physician and dietitian administered questionnaire, physical examination and electrocardiography. All subjects were divided into social classes 1-5 based on attributes of education, occupation, per capita income, housing condition and consumer durables and other family assets. RESULTS: Social classes 1, 2 and 3 were mainly high and middle socioeconomic groups and 3 and 4 low income groups. The prevalence of CAD and coronary risk factors hypercholesterolemia, hypertension, diabetes mellitus and sedentary lifestyle were significantly higher among social classes 1, 2 and 3 in both sexes compared to lower social classes. Mean serum cholesterol, triglycerides, low density lipoprotein cholesterol and blood pressure were significantly associated with higher and middle social classes. Smoking was significantly associated with lower social classes. Multivariate logistic regression analysis after adjustment of age revealed that social class was positively associated with CAD (odds ratio: men 0.84, women 0.86), hypercholesterolemia (men 0.87, women 0.85), hypertension (men 0.91, women 0.89), diabetes mellitus (men 0.71, women 0.68) and sedentary lifestyle (men 0.68, women 0.66). Smoking was significantly associated with CAD in men. CONCLUSION: Social class 1, 2 and 3 in an urban population of India have a higher prevalence of CAD and coronary risk factors hypercholesterolemia, hypertension, diabetes mellitus and sedentary lifestyle in both sexes.
TITLE: Prevalence and risk factors of hypertension and age-specific blood pressures in five cities: a study of Indian women. NKP Salve Institute of Medical Sciences, Nagpur, India. Five City Study Group.
AUTHOR: Singh RB, Beegom R, Mehta AS, Niaz MA, De AK, Haque M, Bhattacharyya PR, Dube GK, Pandit RB, Thakur AS, Wander GS, Janus ED, Postiglione A, Moshiri M
AFFILIATION: Heart Research Laboratory, Medical Hospital and Research Centre, Moradabad, India.
SOURCE: Int J Cardiol 1998 Jan 31;63(2):165-73
ABSTRACT: OBJECTIVE: To measure the prevalence of hypertension and age-specific blood pressure in urban populations from five Indian cities. Cross-sectional surveys were conducted in six-twenty urban streets in different cities from five different corners of India, using similar methods of sample selection and criteria. There were 3212 randomly selected women from Moradabad (n=902), Trivandrum (n=760), Calcutta (n=365), Nagpur (n=405) and Bombay (n=780), aged 25-64 years, inclusive. Evaluation was by a physician and a dietitian, an administered questionnaire, a physical examination and using a sphygmomanometer. The diagnosis of hypertension was based on old World Health Organisation criteria and new World Health Organisation/International Society of Hypertension criteria. The prevalence of hypertension (>140/90 mm Hg) was significantly (P<0.01) high in Trivandrum, South India (30.7%), and Bombay, West India (28.0%), compared to Moradabad, which is in northern India (22.6%), Nagpur, in central India (24.2%), and Calcutta, in east India (19.1%). Mean systolic and diastolic blood pressures were significantly higher in Trivandrum and Bombay compared to the other three cities. The overall prevalence of hypertension was 25.6% (n=823) and isolated diastolic hypertension was the most common form of hypertension (50.5%, n=1506) in the five Indian cities. According to old criteria, the overall prevalence of hypertension (>160/95 mm Hg) was 14.8% (n=481). Multivariate logistic regression analysis on pooled data from the five cities, after adjustment for age, showed that age (odds ratio 1.16), body mass index (1.68) and obesity were strongly associated with hypertension. A sedentary lifestyle and salt intake were weakly associated and alcohol intake was not a factor with these women.
TITLE: Association of trans fatty acids (vegetable ghee) and clarified butter (Indian ghee) intake with higher risk of coronary artery disease in rural and urban populations with low fat consumption.
AUTHOR: Singh RB, Niaz MA, Ghosh S, Beegom R, Rastogi V, Sharma JP, Dube GK
AFFILIATION: Heart Research Laboratory, Medical Hospital and Research Centre, Moradabad, India.
SOURCE: Int J Cardiol 1996 Oct 25;56(3):289-98; discussion 299-300
ABSTRACT: These cross-sectional surveys included 1769 rural (894 men and 875 women) and 1806 urban (904 men and 902 women) randomly selected subjects between 25-64 years of age from Moradabad in North India. The total prevalence of coronary artery disease based on clinical history and electrocardiogram was significantly higher in urban compared to rural men (11.0 vs. 3.9%) and women (6.9 vs. 2.6%), respectively. Food consumption patterns showed that important differences in relation to coronary artery disease were higher intake of total visible fat, milk and milk products, meat, eggs, sugar and jaggery in urban compared to rural subjects. Prevalence of coronary artery disease in relation to visible fat intake showed a higher prevalence rate with higher visible fat intake in both sexes and the trend was significant for total prevalence rates both for rural and urban men and women. Subgroup analysis among urban (694 men and 694 women) and rural (442 men and 435 women) subjects consuming moderate to high fat diets showed that subjects eating trans fatty acids plus clarified butter or those consuming clarified butter as total visible fat had a significantly higher prevalence of coronary artery disease compared to those consuming clarified butter plus vegetable oils in both rural (9.8, 7.1 vs. 3.0%) and urban (16.2, 13.5 vs. 11.0%) men as well as in rural (9.2, 4.5 vs. 1.5%) and urban (10.7, 8.8 vs. 6.4%) women. Univariate and multivariate regression analysis with adjustment for age showed that sedentariness in women, body mass index in urban men and women, milk and clarified butter plus trans fatty acids in both rural and urban in both sexes were significantly associated with coronary artery disease. It is possible that lower intake of total visible fat (20 g/day), decreased intake of milk, increased physical activity and cessation of smoking may benefit some populations in the prevention of coronary artery disease.
TITLE: Coronary heart disease and its risk factors in first-generation immigrant Asian Indians to the United States of America.
AUTHOR: Enas EA, Garg A, Davidson MA, Nair VM, Huet BA, Yusuf S
AFFILIATION: American Association of Physicians from India, University of Texas Southwestern Medical Center at Dallas 75235-9052, USA.
SOURCE: Indian Heart J 1996 Jul-Aug;48(4):343-53
ABSTRACT: The prevalence of coronary heart disease (CHD) and its risk factors in first-generation Asian Indian immigrants to the United States of America (US) were compared with those of the native Caucasian population. A total of 1688 Asian Indian physicians and their family members (1131 men and 557 women, age > or = 20 years) completed a questionnaire and in 580 subjects serum lipoproteins were determined. The age-adjusted prevalence of myocardial infarction and/or angina was approximately three times more in Asian Indian men compared to the Framingham Offspring Study (7.2% versus 2.5%; P < 0.0001) but was similar in women (0.3% versus 1%; p = 0.64). Asian Indians had higher prevalence of noninsulin-dependent diabetes mellitus (NIDDM; 7.6% versus 1%; p < 0.0001) but markedly lower prevalence of cigarette smoking (1.3% versus 27%; p < 0.0001) and obesity (4.2% versus 22%; p < 0.0001). Hypertension was less prevalent in Asian Indian men 14.2% versus 19.1%, p < 0.008) but similar in women (11.3% versus 11.4%). The prevalence of elevated total a low-density lipoprotein (LDL) cholesterol levels was similar in men [17% versus 23.4% (p = 0.24) and 13.7% versus 22.3% (p = 0.22), respectively] but lower in women [15% versus 26.1% (p = 0.018) and 14.3% versus 19.6% (p = 0.047) respectively]. The mean levels of high-density lipoprotein (HDL) cholesterol were less in younger (30-39 years) Asian Indian men (mean: 0.98 versus 1.18 mmol/l; p < 0.001) and middle-aged (30-59 years) women (mean: 1.24 versus 1.45 mmol/l; p < 0.001). The prevalence of hypertriglyceridaemia was similar in men (18.5% versus 11.3%), but higher in Asian Indian women (8.3% versus 4.1%, p = 0.02). To conclude, immigrant Asian Indian men to the US have high prevalence of CHD, NIDDM, low HDL cholesterol levels and hypertriglyceridaemia. All these have "insulin resistance" as a common pathogenetic mechanism and seem to be the most important risk factors. Comments:
TITLE: Hypertension and determinants of blood pressure with special reference to socioeconomic status in a rural south Indian community.
AUTHOR: Gilberts EC, Arnold MJ, Grobbee DE
AFFILIATION: Department of Epidemiology and Biostatistics, Erasmus University, Rotterdam, The Netherlands.
SOURCE: J Epidemiol Community Health 1994 Jun;48(3):258-61
ABSTRACT: OBJECTIVES--The objective of the study was to establish the prevalence of hypertension and to assess determinants of blood pressure with special reference to socioeconomic status in a rural south Indian community. DESIGN--This was a door to door, cross sectional survey. SETTING--A rural south Indian community, KV Kuppam panchayat, North Arcot District, Tamil Nadu. SUBJECTS--The area has a total population of 3500 people. Those aged over 20 years who were available at the time of measurement were asked to participate (mean age 39.5 years). This convenience sample totalled 1027 (456 men, 571 women). Out of 697 families, 487 were visited; 15 people refused to participate. MEASUREMENTS AND MAIN RESULTS--The following potential determinants of blood pressure were assessed: age, body weight, pulse rate, salt intake, meat intake, and socioeconomic class. The prevalence of hypertension was 12.5%. Using multiple linear regression analysis, the most important positive determinants of high blood pressure seemed to be age, body weight, and pulse rate. Salt and meat intake were not significantly associated with hypertension. The prevalence of hypertension in the highest socioeconomic group (22.5%) was more than twice that in the lowest socioeconomic group (8.8%). When adjusted for body weight, the mean (SEM) difference in systolic blood pressure between the highest and lowest socioeconomic classes was 5.83 mmHg (1.63). CONCLUSION--Hypertension is not yet as important a health problem in rural southern India as it is in westernised societies. Those particularly at risk of hypertension, however, are the elderly and overweight people of high socioeconomic class.
TITLE: Ethnicity and variations in the nation's health.
AUTHOR: Balarajan R
AFFILIATION: St Bernards Hospital, Southall, Middlesex, UK.
SOURCE: Health Trends 1995-96;27(4):114-9
ABSTRACT: The variations in the Health of the Nation (HoN) key areas among ethnic minorities living in England and Wales are examined, based on a national mortality study by country of birth for the latest possible period (1988-1992). It addresses the 10 mortality indicators in the HoN White Paper (covering coronary heart disease [CHD] and stroke, cancers, mental illness and accidents), using age-standardised rates adjusted to the European Standard Population. The findings establish variations in the recent health experience of ethnic minorities born outside England and Wales who are now living in England and Wales. CHD among persons aged under 65 years was highest in those born in the Indian Subcontinent, 55% above the normal rate in England and Wales. Caribbeans, and African groups experienced the lowest rates. Stroke mortality under 65 years-of-age was highest in Bangladeshis, followed by other Commonwealth Africans, and then by Caribbeans. Patterns of cancer deaths also varied, with breast cancer mortality rates being lower in all ethnic groups, and lowest in those born in the Indian Subcontinent. By contrast, lung cancer deaths were higher in Irish men and women; lung cancer mortality among Bangladeshi men was significantly higher than Indians and Pakistanis, being only 15% less than that of the rates in England and Wales. Suicides were lowest in Bangladeshis and Pakistanis and highest among Indians and the Irish. Accidental deaths in children were highest in Pakistanis followed by the Irish, who also experienced higher rates among young persons. It is suggested that the HoN strategy should consider setting appropriate and achievable targets, including ones in new areas of relevance to these groups. The National Health Service purchaser/provider framework should respond to the needs of its populations, including ethnic groups.
TITLE: Genotypic Variation in the APOC3 promoter in Asian Indians: A potential culprit for enhanced CHD ?
AUTHOR: Michael Miller, Jeffrey M Rhyne, University of Maryland Hosp-VAMC, Baltimore, MD; Meena Khatta, University of Maryland Hospital, Baltimore, MD; Karen I Zeller, Johns Hopkins Hospital, Baltimore, MD
SOURCE: American Heart Association Scientific Sessions, 8 Nov, 1999. Atlanta Georgia.
ABSTRACT: Not available online.