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Diabetologia

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01.11.2006 | Article

Do known risk factors explain the higher coronary heart disease mortality in South Asian compared with European men? Prospective follow-up of the Southall and Brent studies, UK

verfasst von: N. G. Forouhi, N. Sattar, T. Tillin, P. M. McKeigue, N. Chaturvedi

Erschienen in: Diabetologia | Ausgabe 11/2006

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Abstract

Aims/hypothesis

We examined prospectively whether measured risk factors can explain the higher CHD mortality in South Asians compared with Europeans.

Materials and methods

Conventional CHD risk factors and those associated with insulin resistance were measured in 1,787 European and 1,420 South Asian men aged 40 to 69 years at baseline in the population-based Southall and Brent studies (London) between 1988 and 1990. Participants were followed up for mortality.

Results

By February 2006, there were 202 CHD deaths (108 Asian, 94 European). South Asian men had double the CHD mortality of European men in Cox regression analyses adjusted for age, smoking, and cholesterol (hazard ratio [HR] 2.14, 95% CI 1.56–2.94, p<0.001). Nearly half of all South Asian CHD deaths versus 13% of deaths among Europeans were among persons with diabetes. Asian men had greater CHD mortality than Europeans, both in the with- and the without-diabetes categories at baseline. CHD mortality remained significantly higher in South Asian men in multivariable models that adjusted for conventional risk factors and diabetes and/or impaired glucose regulation, features of insulin resistance, or the metabolic syndrome (HR 1.6–1.9). Accounting for co-morbidity and socio-economic status did not materially alter the findings.

Conclusions/interpretation

These data confirm that South Asian men have significantly higher CHD mortality than their European counterparts, while indicating that neither conventional risk factors, nor insulin resistance parameters or metabolic syndrome criteria as currently defined can account for this excess risk. The contribution of unmeasured factors to the elevated vascular risk in South Asians should be addressed in future studies.

McKeigue PM, Miller GJ, Marmot MG (1989) Coronary heart disease in South Asians overseas: a review. J Clin Epidemiol 42:597–609PubMedCrossRef

Wild S, McKeigue P (1997) Mortality by country of birth in England and Wales, 1970–1992. Br Med J 314:689–762

McKeigue PM, Ferrie JE, Pierpoint T et al (1993) Association of early-onset coronary heart disease in South Asian men with glucose intolerance and hyperinsulinemia. Circulation 87:152–161PubMed

McKeigue PM, Shah B, Marmot MG (1991) Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians. Lancet 337:382–386PubMedCrossRef

Knight TM, Smith Z, Sahota P et al (1992) Insulin resistance, diabetes, and risk markers for ischaemic heart disease in Asian men and non-Asian men in Bradford. Br Heart J 67:343–350PubMed

Hughes K, Aw T-C, Kuperan P et al (1997) Central obesity, insulin resistance, syndrome X, lipoprotein(a), and cardiovascular risk in Indians, Malays, and Chinese in Singapore. J Epidemiol Community Health 51:394–399PubMed

Dhawan J, Bray CL, Warburton R et al (1994) Insulin resistance, high prevalence of diabetes, and cardiovascular risk in immigrant Asians: genetic or environmental effect? Br Heart J 72:413–421PubMed

Hughes LO, Cruickshank JK, Wright J et al (1989) Disturbances of insulin in British Asian and white men surviving myocardial infarction. Br Med J 299:537–541CrossRef

Chambers JC, McGregor A, Jean-Marie J et al (1999) Abnormalities of vascular endothelial function may contribute to increased coronary heart disease risk in UK Indian Asians. Heart 81:501–504PubMed

10.

Hoogeveen RC, Gambhir JK, Gambhir DS et al (2001) Evaluation of Lp[a] and other independent risk factors for CHD in Asian Indians and their USA counterparts. J Lipid Res 42:631–638PubMed

11.

Miller GJ, Beckles GL, Maude GH et al (1989) Ethnicity and other characteristics predictive of coronary heart disease in a developing community: principal results of the St James Survey, Trinidad. Int J Epidemiol 18:808–817PubMed

12.

Collins VR, Dowse GK, Cabealawa S et al (1996) High mortality from cardiovascular disease and analysis of risk factors in Indian and Melanesian Fijians. Int J Epidemiol 25:59–69PubMed

13.

Chaturvedi N, McKeigue PM, Marmot MG (1993) Resting and ambulatory blood pressure differences in Afro-Caribbeans and Europeans. Hypertension 22:90–96PubMed

14.

World Health Organization (1999) Definition, diagnosis and classification of diabetes mellitus. Part I. WHO, Geneva

15.

International Diabetes Federation (2005) The IDF consensus worldwide definition of the metabolic syndrome. http://www.idf.org/webdata/docs/IDF_Metasyndrome_definition.pdf (accessed May 2006)

16.

Matthews DR, Hosker JP, Rudenski AS et al (1985) Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28:412–419PubMedCrossRef

17.

UK Prospective Diabetes Study Group (1998) Ethnicity and cardiovascular disease. The incidence of myocardial infarction in white, South Asian and Afro-Caribbean patients with type 2 diabetes (UK Prospective Diabetes Study 32). Diabetes Care 21:1271–1277

18.

Chaturvedi N, Fuller JH (1996) Ethnic differences in mortality from cardiovascular disease in the UK: do they persist in people with diabetes? J Epidemiol Community Health 50:137–139PubMedCrossRef

19.

Mather HM, Chaturvedi N, Fuller JH (1998) Mortality and morbidity from diabetes in South Asians and Europeans: 11-year follow-up of the Southall Diabetes Survey, London, UK. Diabet Med 15:53–59PubMedCrossRef

20.

Mukhopadhyay B, Forouhi NG, Fisher BM et al (2006) Glycaemic control over time among European and South Asian patients with type 2 diabetes: results from follow up in a routine diabetes clinic. Diabetic Med 23:94–98PubMedCrossRef

21.

Chambers JC, Eda S, Bassett P et al (2001) C-reactive protein, insulin resistance, central obesity, and coronary heart disease risk in Indian Asians from the United Kingdom compared with European whites. Circulation 104:145–150PubMed

22.

Forouhi NG, Sattar N, McKeigue PM (2001) Relation of C-reactive protein to body fat distribution and features of the metabolic syndrome in Europeans and South Asians. Int J Obes Relat Metab Disord 25:1327–1331PubMedCrossRef

23.

Abate N, Chandalia M, Snell PG et al (2004) Adipose tissue metabolites and insulin resistance in nondiabetic Asian Indian men. J Clin Endocrinol Metab 89:2750–2755PubMedCrossRef

24.

Bhatnagar D, Anand IS, Durrington PN et al (1995) Coronary risk factors in people from the Indian subcontinent living in West London and their siblings in India. Lancet 345:405–409PubMedCrossRef

25.

Fischbacher CM, Hunt S, Alexander L (2004) How physically active are South Asians in the United Kingdom? A literature review. J Public Health (Oxf) 26:250–258CrossRef

26.

Adamson J, Ben Shlomo Y, Chaturvedi N et al (2003) Ethnicity, socio-economic position and gender—do they affect reported health-care seeking behaviour? Soc Sci Med 57:895–904PubMedCrossRef

27.

Britton A, Shipley M, Marmot M et al (2004) Does access to cardiac investigation and treatment contribute to social and ethnic differences in coronary heart disease? Whitehall II Prospective Cohort Study. Br Med J 329:318CrossRef

28.

Pollard TM, Carlin LE, Bhopal R et al (2003) Social networks and coronary heart disease risk factors in South Asians and Europeans in the UK. Ethn Health 8:263–275PubMedCrossRef

29.

Office for National Statistics (2004) The impact of introducing ICD-10 on trends in mortality from circulatory diseases in England and Wales. Health Stat Q 22:14–20

30.

Joint British Societies (2005) JBS 2: Joint British Societies’ guidelines on prevention of cardiovascular disease in clinical practice. Heart 91 (Suppl 5):v1–v52

31.

Sattar N, Forouhi NG (2005) Metabolic syndrome criteria: ready for clinical prime time or work in progress? Eur Heart J 26:1249–1251PubMedCrossRef

32.

Greenland P (2005) Critical questions about the metabolic syndrome. Circulation 112:3675–3676PubMedCrossRef

33.

Lawlor DA, Smith GD, Ebrahim S (2006) Does the new International Diabetes Federation definition of the metabolic syndrome predict CHD any more strongly than older definitions? Findings from the British Women’s Heart and Health Study. Diabetologia 49:41–48PubMedCrossRef

Titel: Do known risk factors explain the higher coronary heart disease mortality in South Asian compared with European men? Prospective follow-up of the Southall and Brent studies, UK
verfasst von: N. G. Forouhi
N. Sattar
T. Tillin
P. M. McKeigue
N. Chaturvedi
Publikationsdatum: 01.11.2006
Verlag: Springer-Verlag
Erschienen in: Diabetologia / Ausgabe 11/2006
Print ISSN: 0012-186X
Elektronische ISSN: 1432-0428
DOI: https://doi.org/10.1007/s00125-006-0393-2

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Do known risk factors explain the higher coronary heart disease mortality in South Asian compared with European men? Prospective follow-up of the Southall and Brent studies, UK

Abstract

Aims/hypothesis

Materials and methods

Results

Conclusions/interpretation

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