Key result
South Asian patients had a higher risk of death in the six months following acute myocardial infarction compared to white patients, largely attributable to a higher prevalence of diabetes.
Why the study?
Does South Asian ethnicity increase six-month mortality in patients under 65 years admitted with acute myocardial infarction compared to white ethnicity?
Observational (n=462)
No
Does South Asian ethnicity increase six-month mortality in patients under 65 years admitted with acute myocardial infarction compared to white ethnicity?
South Asian patients have a higher six-month mortality after acute myocardial infarction compared to white patients, which appears largely attributable to a higher baseline prevalence of diabetes.
Answers are grounded in this paper and cite their sources.
May inform targeted diabetes management in South Asian AMI patients; hypothesis-generating for independent ethnic effects.
Objective : To compare mortality in south Asian (Indian, Pakistani, and Bangladeshi) and white patients in the six months after hospital admission for acute myocardial infarction. Design : Observational study. Setting : District general hospital in east London. Patients : 149 south Asian and 313 white patients aged <65 years admitted to the coronary care unit with acute myocardial infarction from 1 December 1988 to 31 December 1992. Main outcome measure : All cause mortality in the first six months after myocardial infarction. Results : The admission rate in the south Asians was estimated to be 2.04 times that in the white patients. Most aspects of treatment were similar in the two groups, except that a higher proportion of the south Asians received thrombolytic drugs (81.2% v 73.8%). After adjustment for age, sex, previous myocardial infarction, and treatment with thrombolysis or aspirin, or both, the south Asians had a poorer survival over the six months from myocardial infarction (hazard ratio 2.02 (95% confidence interval 1.14 to 3.56), P=0.018), but a substantially higher proportion were diabetic (38% v 11%, P<0.001), and additional adjustment for diabetes removed much of their excess risk (adjusted hazard ratio 1.26 (0.68 to 2.33), P=0.47). Conclusion : South Asian patients had a higher risk of admission with myocardial infarction and a higher risk of death over the ensuing six months than the white patients. The higher case fatality among the south Asians, largely attributable to diabetes, may contribute to the increased risk of death from coronary heart disease in south Asians living in Britain. Key messages This study shows that south Asians have high mortality in the first six months after a heart attack This may contribute to the high standardised mortality ratios for coronary disease in south Asians living in the Britain Diabetes may be an important contributor to this excess risk The high prevalence of diabetes and relatively poor prognosis after myocardial infarction in south Asian patients are important to consider in clinical management
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Wilkinson et al. (1996) conducted an observational in Acute myocardial infarction (n=462). South Asian ethnicity vs. White ethnicity was evaluated on All cause mortality in the first six months after myocardial infarction (HR 2.02, 95% CI 1.14 to 3.56, p=0.018). South Asian patients had a higher risk of death in the six months following acute myocardial infarction compared to white patients, largely attributable to a higher prevalence of diabetes.
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