Differences in mortality and morbidity in African Caribbean and European people with non-insulin dependent diabetes mellitus: results of 20 year follow up of a London cohort of a multinational study

Chaturvedi, Nish; Jarrett, John C.; Morrish, N; Keen, H.; Fuller, John

doi:10.1136/bmj.313.7061.848

Cited by 71 publications

(78 citation statements)

References 35 publications

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“…A review of the literature provided several estimates of the RRs of these outcomes. [20][21][22][23][24][25][26][27][28][29][30][31][32][33] However, the Asia Pacific Cohort Studies Collaboration 34 includes most of the prospective observational studies conducted in both Indian and Caucasian populations in the region. It provides reliable evidence on the effects of a variety of modifiable risk factors, including diabetes, on the risks of major cardiovascular diseases and other common causes of death in populations from this region.…”

Section: Methodsmentioning

confidence: 99%

Estimating the burden of disease attributable to diabetes in South Africa in 2000

Bradshaw

Pieterse

Levitt

2007

Journal of Endocrinology, Metabolism and Diabetes of South Afri

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Section: Methodsmentioning

confidence: 99%

Estimating the burden of disease attributable to diabetes in South Africa in 2000

Bradshaw

Pieterse

Levitt

2007

Journal of Endocrinology, Metabolism and Diabetes of South Afri

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“…People of Black African descent (African Caribbeans) are particularly susceptible to diabetes, with a prevalence three times that of populations of European origin [2]. The risk of vascular complications such as nephropathy, left ventricular hypertrophy and stroke is also higher than can be accounted for by rates of diabetes or other concomitant cardiovascular risk factors, such as hypertension [3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Differences in the association between type 2 diabetes and impaired microvascular function among Europeans and African Caribbeans

et al. 2005

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Aims/hypothesis: Diabetes is associated with microvascular damage in all populations, but diabetic patients of Black African descent (African Caribbeans) have a greater risk of vascular target organ damage than would be anticipated for any given blood pressure level. We investigated whether this may be due to differences in the microvasculature. Materials and methods: To assess the maximum hyperaemic response to heating and the post-ischaemic response, Laser Doppler fluximetry was performed on 51 and 100 Europeans, and on 66 and 88 African Caribbeans with and without diabetes, respectively. Subjects were aged between 40 and 65 years and recruited from the general population. Echocardiographic interventricular septal thickness (IVST) was measured as a proxy for vascular target organ damage. Results: In diabetic subjects of both ethnic groups, the maximum hyperaemic response and peak response to ischaemia were attenuated as compared to the corresponding non-diabetic subjects (p=0.08 for diabetic and 0.03 for non-diabetic Europeans; p=0.03 and 0.1 for African Caribbeans). Adjustment for cardiovascular risk factors, in particular insulin and blood pressure, abolished these differences in Europeans (p=0.8 for diabetic and 0.2 for non-diabetic Europeans), but not in African Caribbeans (p=0.03 and 0.05). Conclusions/interpretation: Persisting microvascular dysfunction in African Caribbeans may contribute to the increased risk of target organ damage observed in diabetes in this population. The weak contribution of conventional cardiovascular risk factors to these disturbances indicates that conventional therapeutic interventions may be less beneficial in these patients. There was a risk-factor-independent, inverse association between IVST and maximal hyperaemia. These ethnic differences in microvascular responses to temperature and arterial occlusion could account for increased target organ damage in African Caribbeans.

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“…is an urgency for prevention program due to increased burden of CVD in type 2 diabetes in India [4][5][6][7][8][9][10][11]. Conventional risk factors common among Indian immigrants to industrialized countries are not able to explain the cause of higher risk of CVD mortality among these populations [11][12][13][14]. International College of Cardiology, The Tsim Tsoum Institute, Poland, Indian Society of Hypertension and International College of Nutrition and other experts have proposed guidelines for prevention of CVD and diabetes in Indians and Asians.…”

Section: Causes Of Mortalitymentioning

confidence: 99%

“…shown that the incidence and mortality rates for CAD are 50-300% higher among overseas South Asians compared with compatriots of other ethnicities [5][6][7][8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Prevention of Cardiovascular Disease and Diabetes Mellitus In Low and Middle Income Countries

Rastogi¹

2011

TONUTRAJ

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Hyperglycemia as a component of metabolic syndrome, appears to be an important risk marker of vascular disease in most developing countries which are under transition from poverty to affluence. Despite a moderate increase in fat intake and low rates of obesity, the risk of coronary artery disease (CAD) and diabetes is rapidly increasing in most of the developing economies. It is a paradox that in some of these countries the increased risk of people to diabetes and CAD, especially at a younger age, is difficult to explain by conventional risk factors. It is possible that the presence of new risk factors especially higher lipoprotein (a)(Lpa), hyperhomocysteinemia, insulin resistance, low high density lipoprotein cholesterol and poor nutrition during fetal life, infancy and childhood may explain at least in part, the cause of this paradox. The prevalence of obesity, central obesity, smoking, physical inactivity and stress are rapidly increasing in low and middle income populations, due to economic development. In high income populations, there is a decrease in tobacco consumption, increase in physical activity and dietary restrictions, due to learning of the message of prevention, resulting into reduction in coronary and sroke mortality. Hypertension, (5-10%) diabetes(3-5%) and CAD(3-4%) are very low in the adult, rural populations of India, China, and in the African sub-continent which has less economic development. However, in urban and immigrant populations of India and China, the prevalence of hypertension (>140/90, 25-30%), diabetes (6-18%) and CAD (7-14%) are significantly higher than they are in some of the high income populations. Mean serum cholesterol (180-200 mg/dl), obesity (5-8%) and dietary fat intake (25-30% en/day) are paradoxically not very high and do not explain the cause of increased susceptibility to CAD and diabetes in some South Asian countries. The force of lipid-related risk factors and refined starches and sugar appears to be greater in these populations due to the presence of the above factors and results into CVD and diabetes at a younger age in these countries. These findings may require modification of the existing American and European guidelines, proposed for prevention of CAD, in high income populations. Wild foods or designer foods (400-500g/day) substitution (www.columbus-concept.com) for proatherogenic foods; in conjunction with moderate physical activity and cessation of tobacco, may be protective against deaths and disability due to CVD and diabetes in most of these countries.

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Differences in mortality and morbidity in African Caribbean and European people with non-insulin dependent diabetes mellitus: results of 20 year follow up of a London cohort of a multinational study

Abstract: African Caribbeans with non-insulin dependent diabetes maintain a low risk of heart disease. Management priorities for diabetes developed in one ethnic group may not necessarily be applicable to other groups.

Cited by 71 publications

References 35 publications

Estimating the burden of disease attributable to diabetes in South Africa in 2000

Estimating the burden of disease attributable to diabetes in South Africa in 2000

Differences in the association between type 2 diabetes and impaired microvascular function among Europeans and African Caribbeans

Prevention of Cardiovascular Disease and Diabetes Mellitus In Low and Middle Income Countries

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