Coronary artery disease in Asians in Birmingham.

Lowry, P J; Glover, D. R.; Mace, P. J. E.; Littler, W. A.

doi:10.1136/hrt.52.6.610

Cited by 39 publications

(21 citation statements)

References 11 publications

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“…Furthermore, the excess mortality in south Asian immigrants steadily increased with decreasing age [8]. Other studies have also reported that south Asians frequently have premature atherosclerosis with more diffuse and aggressive disease than their Caucasian counterparts [7,26].…”

Section: The Prevalence Of Type 2 Diabetes and Cardiovascular Diseasementioning

confidence: 80%

Type 2 diabetes and cardiovascular risk in the UK south Asian community

et al. 2006

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A popular hypothesis for the greater prevalence of type 2 diabetes and cardiovascular disease in UK south Asians is that they have an increased susceptibility of developing insulin resistance in response to certain environmental factors, including obesity and adoption of a sedentary lifestyle. Insulin resistance is postulated as a central feature of the metabolic syndrome, culminating in type 2 diabetes, atherosclerotic vascular disease and CHD; a pathway potentially accelerated by migration/ urbanisation. We describe and compare the prevalence of type 2 diabetes, cardiovascular disease and their associated risk factors in UK south Asian and white Caucasian populations to determine possible reasons for the increased preponderance of these diseases in south Asians, and highlight key evidence for optimal risk factor management. Finally, we describe a UK communitybased programme that attempts to reduce the morbidity and mortality from type 2 diabetes and cardiovascular disease in south Asians through a new approach to management.

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Section: The Prevalence Of Type 2 Diabetes and Cardiovascular Diseasementioning

confidence: 80%

Type 2 diabetes and cardiovascular risk in the UK south Asian community

et al. 2006

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“…The majority of Indo-Asians in the West Midlands come from India and Pakistan; the remainder are from Bangladesh or are Indo-Asians from East Africa [7] . Eighty-eight percent of our Indo-Asian patients originate from the North Indian subcontinent (Punjab and Pakistan).…”

Section: Patientsmentioning

confidence: 99%

“…Furthermore, mortality from coronary heart disease in this group is higher than in the indigenous white Caucasian population, as is the incidence of a further coronary event after the first myocardial infarction [2] . Although the North American literature describes racial differences in the use of invasive procedures in the management of cardiac disease, including coronary artery bypass grafting [2][3][4] , the experience in the United Kingdom does not reflect these differences [2,[5][6][7] . Dissimilarities in the management of cardiac disease, therefore, cannot fully explain the higher mortality in the Indo-Asian ethnic group.…”

Section: Introductionmentioning

confidence: 99%

Comparison of primary coronary artery bypass surgery in a British Indo-Asian and white Caucasian population

Goldsmith

Lip²,

Tsang³

et al. 1999

European Heart Journal

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Aim To compare the clinical characteristics, at the time of admission and after coronary revascularization by bypass surgery, among British patients of Indo-Asian and white Caucasian descent.Method One hundred and ninety-four pairs of patients admitted between November 1994 and January 1997 were matched for age (within 3 years), sex and date of admission (within 3 months). Their clinical characteristics at the time of admission for coronary artery bypass grafting surgery, and the incidence of hospital morbidity, hospital mortality and length of stay in the intensive therapy unit or hospital following coronary artery bypass grafting were determined.Results A higher proportion of Indo-Asian patients underwent coronary revascularization on a non-elective basis (43% vs 32% white Caucasian patients, P=0·018), had a higher prevalence of diabetes (39% vs 12%, P=0·0001), a lower prevalence of smoking (36% vs 80%, P=0·0001) and a lower rate of previous myocardial infarction (47% vs 62%, P=0·012). As regards revascularization, although there was no significant difference in the number of vessels revascularized, there was a lower use of the arterial conduit (internal mammary artery) in the Indo-Asian patients (72% vs 81%, P=0·028) particularly for those undergoing emergency/urgent surgery (59% vs 72%, P=0·001) and with a previous myocardial infarction (65% vs 81%; P=0·01) when compared with their white Caucasian counterparts. Following surgery there were no differences in the types of support required for vital functions. There was no significant difference in the proportion of major post-operative complications, that is, haemorrhage, cerebrovascular accident, renal failure requiring dialysis or respiratory failure. Similarly, there were no differences in the length of intensive therapy unit stay (median stay 1 day vs 1 day, P=0·4) and hospital stay following surgery (median stay 6 days vs 6 days, P=0·5) between the two groups. Although there was a trend towards a higher in-hospital (30 day) mortality (6·7% [95% confidence intervals CI 3·18-10·21] vs 2·6% [CI 0·35-4·9; P=0·0618]), in Indo-Asians compared to white Caucasians this trend disappeared when patients in the two groups undergoing non-elective surgery only were compared (9% vs 7%; P=0·7).Conclusions A higher proportion of Indo-Asians underwent non-elective coronary revascularization, with a significantly lower use of the arterial conduit and a relatively higher in-hospital mortality. Following coronary revascularization the medical management, length of stay and hospital morbidity in Indo-Asian patients was no different from that of their white Caucasian counterparts. This is despite a perceived poorer outcome in Indo-Asians compared to white Caucasians.

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“…Autopsies also revealed more severe and extensive atherosclerosis and larger infarct size and increased frequency of triple vessel disease among Indians. [2] In CAD, fi rst reported from Singapore in 1959 reveal that people hailing from Indian subcontinent had a higher probability of dying due to CAD. The overall age standardized mortality ratio of CAD in Asian males compared to whites was 37.3% higher in age group of 20-29 years, compared to 36% higher at all ages in the UK.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of serum lipoprotein (a) in young patients with myocardial infarction

Kamariya¹,

Gorasia²,

Vachhani³

et al. 2014

Int J Med Public Health

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Context: Indians are prone as a community to coronary artery disease (CAD) at a much younger age. CAD is affecting Indians 5-10 years earlier than other communities. Lipoprotein (a) (Lp (a)) is now recognized as an independent risk factor for CAD. It is a genetic risk factor. Aim: We evaluate the Lp (a) in young patients with myocardial infarction (MI). Settings and design: Study population consisted of 50 patients having MI and 50 control groups. Subjects and Methods: Fasting samples were collected from patients and were analyzed for Lp (a), lipid profi le, and blood sugar on fully automated analyzer. Statistical analysis used: Statistical analysis is carried out by using Student's t-test. Results: The difference in total cholesterol (P = 0.8192), high density lipoprotein-cholesterol (HDL-C) (P = 0.11), low density lipoprotein-cholesterol (LDL-C) (P = 0.8143), triglyceride (P = 0.1177) levels, and total cholesterol/HDLcholesterol ratio (P = 0.2129) were observed between the case and control groups in this study was not statistically signifi cant. The difference in the Lp (a) levels between the case and control groups was highly signifi cant (P-value = 0.0001). Conclusions:This study demonstrated that in young patients with MI there was a male predominance. Lp (a) level is an important and independent risk factor for CAD. Serum Lp (a) level is not dependent on serum total cholesterol level.

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Coronary artery disease in Asians in Birmingham.

Cited by 39 publications

References 11 publications

Type 2 diabetes and cardiovascular risk in the UK south Asian community

Type 2 diabetes and cardiovascular risk in the UK south Asian community

Comparison of primary coronary artery bypass surgery in a British Indo-Asian and white Caucasian population

Evaluation of serum lipoprotein (a) in young patients with myocardial infarction

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