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Coronary heart disease in UK Indian Asians: the potential for reducing mortality
  1. Consultant Cardiologist,
  2. Imperial College School of Medicine,
  3. Hammersmith Hospital Campus,
  4. London W12 0NN, UK

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The latest census data confirm that coronary heart disease (CHD) mortality in Indian Asians living in the UK remains 38% higher in men and 43% higher in women compared to Europeans.1However, the burden of CHD in UK Indian Asians is greatest in young men in whom the relative risk is at least twofold higher compared to Europeans. There is also some loss of immunity from CHD in Indian Asian women. Recent reports of a reduction in CHD rates among Indian Asians and Europeans provide encouragement that accurate diagnosis, novel and effective treatment strategies, and control of risk factors in the past decade have benefitted both groups.1

Coronary risk factors in Indian Asians

The prevalence of classic risk factors such as smoking, hypercholesterolaemia, and hypertension are generally lower in Indian Asians than in Europeans,2 implying that classic risk factors do not account for the excess CHD mortality in Indian Asians.3 However, this view is based on the inherent assumption that reference levels of risk factors in Europeans apply equally to UK Indian Asians. Comparisons between migrant Indian Asians and their non-migrant siblings indicate significantly higher serum cholesterol, blood pressure, smoking rates, and body mass index in the former. Although, the extent to which classic risk factors contribute to CHD remains unclear, they undoubtedly have important influences on excess CHD rates in UK Indian Asians. Insulin resistance, and its metabolic consequences, are increasingly recognised as risk factors for CHD.4 Insulin resistance, characterised by glucose intolerance, raised plasma insulin, increased triglycerides, decreased high density lipoprotein (HDL) cholesterol, and central obesity, is more prevalent in UK Indian Asians than Europeans.3

In European populations the risk of myocardial infarction (MI) may be increased by 10-fold with a family history of premature CHD.5 In Indian Asians, part of the increased risk in susceptible families …

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