Premature Coronary Heart Disease in South Asians: Burden and Determinants

Ahmed, Sarah T.; Rehman, Hasan; Akeroyd, Julia M.; Alam, Mahboob; Shah, Tina; Kalra, Ankur; Virani, Salim S.

doi:10.1007/s11883-018-0706-1

Cited by 46 publications

(36 citation statements)

References 40 publications

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“…Our observations for the South Asian group are consistent with those from prior reports in both the Asian subcontinent, as well as in other Western countries of destination, where South Asians consistently showed a very high prevalence of metabolic abnormalities, especially diabetes, and of premature and aggressive CHD 5 8 14–17. A number of potential underlying mechanisms have been proposed, including genetic predisposing factors, cultural and lifestyle determinants such as low levels of physical activity or diets rich in highly atherogenic fat, and metabolic factors such as abdominal adiposity, insulin resistance, high-density lipoprotein cholesterol abnormalities or high levels of Lp[a], among others 5 8 14–21…”

Section: Discussionsupporting

confidence: 91%

Cardiovascular risk factors and disease among non-European immigrants living in Catalonia

Cainzos‐Achirica

Vela

Clèries

et al. 2019

Heart

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ObjectiveTo describe the prevalence and incidence of cardiovascular risk factors, established cardiovascular disease (CVD) and cardiovascular medication use, among immigrant individuals of diverse national origins living in Catalonia (Spain), a region receiving large groups of immigrants from all around the world, and with universal access to healthcare.MethodsWe conducted a population-based analysis including >6 million adult individuals living in Catalonia, using the local administrative healthcare databases. Immigrants were classified in 6 World Bank geographic areas: Latin America/Caribbean, North Africa/Middle East, sub-Saharan Africa, East Asia and South Asia. Prevalence calculations were set as of 31 December 2017.ResultsImmigrant groups were younger than the local population; despite this, the prevalence of CVD risk factors and of established CVD was very high in some immigrant subgroups compared with local individuals. South Asians had the highest prevalence of diabetes, and of hyperlipidemia among adults aged <55 years; hypertension was highly prevalent among sub-Saharan Africans, and obesity was most common among women of African and South Asian ancestry. In this context, South Asians had the highest prevalence of coronary heart disease across all groups, and of heart failure among women. Heart failure was also highly prevalent in African women.ConclusionsThe high prevalence of risk factors and established CVD among South Asians and sub-Saharan Africans stresses the need for tailored, aggressive health promotion interventions. These are likely to be beneficial in Catalonia, and in countries receiving similar migratory fluxes, as well as in their countries of origin.

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Section: Discussionsupporting

confidence: 91%

Cardiovascular risk factors and disease among non-European immigrants living in Catalonia

Cainzos‐Achirica

Vela

Clèries

et al. 2019

Heart

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“…In general, there seems to be a global rise in the incidence and prevalence of atherosclerotic diseases. But, a premature and rapidly progressive (“malignant”) involvement of the coronary arteries occurs in South Asia, particularly India (15.4% in our series), and this is seen not only in individuals settled in that region but also in the immigrant population, with a lower incidence of less than 3% seen in the Western population [9]. Predictably, males (84.5%) outnumbered women (15.5%).…”

Section: Discussionmentioning

confidence: 77%

“…Predictably, males (84.5%) outnumbered women (15.5%). Hypertension, DM, smoking, dyslipidemia, obesity, sedentary life style and positive family history continue to be the traditional risk factors [4, 9]. Hypertension and/or DM was noted in 40.5%, while a history of smoking was documented in only five patients.…”

Section: Discussionmentioning

confidence: 99%

Pathology of atherosclerotic coronary artery disease in the young Indian population

Vaideeswar

Tyagi

Singaravel

2019

Forensic Sciences Research

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Atherosclerotic coronary artery disease (CAD) is of great concern in young adults because of its potential to cause great incapacitation. This arena of cardiology has gained importance in South Asian countries, particularly India due to increased prevalence that is related to traditional risk factors, altered life styles and inherent risk factors. In this study, we sought to evaluate, at autopsy, the pathology of atherosclerotic CAD in young patients with ischemic heart disease (IHD). A 10-year retrospective autopsy-based study was carried out in a large tertiary-care centre and patients aged ≤45 years with IHD were selected. Out of 545 autopsied cases of IHD, 95 patients (17.4%) were young. Among these 95 patients, 84 (88.4%) had IHD related to atherosclerotic CAD; the youngest patient was 18 years old. Predictably there was sole involvement of left anterior descending artery and the presence of fibrous plaques. Irrespective of the plaque morphology, the commonest complication was thrombosis produced by plaque erosion seen in 36.9% of patients. Acute coronary insufficiency was noted in 52 patients (61.9%), while healed infarctions were surprisingly noted in 28 patients (33.3%). Screening for IHD in the young population may help to improve prognosis by detecting subclinical disease, although more studies are necessary to establish reference limits for this young population. Additional research must also focus on treatment concerns that are specific to young patients.

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“…South Asians, or people who trace their ancestry to the Indian subcontinent, have been observed to exhibit higher indicators of cardiometabolic risk relative to White populations [ 8 ]. The region has seen an epidemiological shift from communicable to noncommunicable diseases (NCDs) in the last few decades due to improved socioeconomic conditions and high rates of rural to urban migration [ 9 ]. Studies have shown that the South Asian ethnicity is associated with higher incidence of CHD [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Sex Difference in Risk Factors, GRACE Scores, and Management among Post-Acute Coronary Syndrome Patients in Sri Lanka

Galappatthy

Bataduwaarachchi

Ranasinghe

et al. 2020

Cardiology Research and Practice

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Objective. To assess sex-based differences in the prevalence of risk factor, their management, and differences in the prognosis among acute coronary syndrome (ACS) in Sri Lanka. Methods. Patients diagnosed with ACS were recruited from hospitals throughout the island. The Joint European Societies guidelines were used to assess recommended targets for coronary heart disease risk factors, and the GRACE score was used to assess the post-ACS prognosis. Age-adjusted regression was performed to calculate odds ratios for men versus women in risk factor control. Results. A total of 2116 patients, of whom 1242 (58.7%) were men, were included. Significant proportion of women were nonsmokers; OR = 0.11 (95% CI 0.09 to 0.13). The prevalence of hypertension (p<0.001), diabetes (p<0.001), and dyslipidemia (p=0.004) was higher in women. The LDL-C target was achieved in a significantly higher percentage of women (12.6%); OR = 0.33 (95% CI 0.10 to 1.05). When stratified by age, no significant differences were observed in achieving the risk factor targets or management strategies used except for fasting blood sugar (p<0.05) where more men achieved control target in both age categories. Majority of the ACS patients had either high or intermediate risk for one-year mortality as per the GRACE score. In-hospital and 1-year mean mortality risk was significantly higher among men of less than 65 years of age (p<0.05). Conclusions. Smoking is significantly lower among Sri Lankan women diagnosed with ACS. However, hypertension, diabetes, and dyslipidemia were more prevalent among them. There was no difference in primary and secondary preventive strategies and management in both sexes but could be further improved in both groups.

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Premature Coronary Heart Disease in South Asians: Burden and Determinants

Cited by 46 publications

References 40 publications

Cardiovascular risk factors and disease among non-European immigrants living in Catalonia

Cardiovascular risk factors and disease among non-European immigrants living in Catalonia

Pathology of atherosclerotic coronary artery disease in the young Indian population

Sex Difference in Risk Factors, GRACE Scores, and Management among Post-Acute Coronary Syndrome Patients in Sri Lanka

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