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  1. Nish Chaturvedi
  1. Correspondence to:
    Professor Nish Chaturvedi, International Centre for Circulatory Health and Department of Epidemiology and Public Health, Faculty of Medicine at St Mary’s, Imperial College London, Norfolk Place, London W2 1PG, UK;

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People of non-European origin form around 7% of the total UK population. Most of these are of South Asian (that is, from the Indian subcontinent) or Black African (that is, from the Caribbean and West Africa) descent. For these migrants, as for virtually all population groups living in the western world, cardiovascular disease (CVD) is the main cause of death. But there are striking ethnic differences in CVD risk. Disease presentation may differ, challenging diagnostic skills, and therapeutic requirements and responses may also not be uniform. The study of ethnic differences in CVD has provided valuable aetiological clues, not just for ethnic minority groups but also for the majority population.


Migrants of South Asian descent worldwide have elevated risks of morbid and mortal events because of ischaemic heart disease (IHD).1 In the UK, mortality from IHD in both South Asian men and women is 1.5 times that of the general population (fig 1),2 and South Asians have not benefited to the same extent from the general decline in deaths caused by IHD over the last few decades. These ethnic differences are greatest in the youngest age groups.

Figure 1

Standardised mortality ratios (SMR) for heart disease and stroke in South Asians and African Caribbeans compared to Europeans, age 20–69, from 1989–92. Adapted from Wild and McKeigue,2 with permission from the BMJ Publishing Group.

These ethnic differences have been extensively studied, and while classical risk factors, such as smoking, blood pressure, obesity, and cholesterol vary substantially between subgroups of South Asians—such that in some cases, levels are equivalent to, or lower than, a comparable European population—levels of glucose intolerance, central obesity (as measured by waist to hip ratio), fasting triglyceride, and insulin are uniformly elevated compared to Europeans (table 1).3 As the elevated risk of …

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