Key result
South Asian ethnicity is associated with higher rates of cardiovascular disease compared with Europeans and Chinese, which is only partly explained by conventional risk factors and atherosclerosis.
Differences in conventional risk factors and atherosclerosis do not fully account for the increased cardiovascular risk observed in South Asian populations compared to Europeans and Chinese.
Cardiovascular disease mortality rates have been known for decades to differ sharply among countries, with up to five-fold to ten-fold higher death rates from coronary heart disease in eastern and northern Europe than in Japan or Mediterranean southern Europe (figure). 1 Morbidity and Mortality: 2000 Chart Book on Cardiovascular, Lung, and Blood Diseases. National Institutes of Health, National Heat, Lung, and Blood Institute, Bethesda, MD2000: 34 Google Scholar These differences are only partly explained by established risk factors. In the Seven Countries Study, the relative risks for cardiovascular disease across blood pressure or cholesterol levels were similar in diverse populations, although the absolute risks differed considerably. 2 van den Hoogen PCW Feskens EJM Nagelkerke NJD Menotti A Nissinen A Kromhout D The relations between blood pressure and mortality due to coronary heart disease among men in different parts of the world. N Engl J Med. 2000; 342: 1-8 Crossref PubMed Scopus (453) Google Scholar Explanations for the disparities in event rates have focused not only on differences in health care but also on lifestyle and genetics. Lifestyle exerts considerable influences on risk factors and rates of cardiovascular events; ecological studies have shown that migration confers changes in risk factors and event rates, with immigrants partly taking on the characteristics of their hosts. 3 Yano K MacLean CJ Reed DM et al. A comparison of the 12‐year mortality and predictive factors of coronary heart disease among Japanese men in Japan and Hawaii. Am J Epidemiol. 1988; 127: 476-487 PubMed Google Scholar Genes, apart from influencing risk factors for cardiovascular disease, may also mediate ethnic differences in susceptibility to this disease. Differences in risk factors, atherosclerosis, and cardiovascular disease between ethnic groups in Canada: the Study of Health Assessment and Risk in Ethnic groups (SHARE)Although there are differences in conventional and novel risk factors between ethnic groups, this variation and the degree of atherosclerosis only partly explains the higher rates of cardiovascular disease among South Asians compared with Europeans and Chinese. The increased risk of cardiovascular events could be due to factors affecting plaque rupture, the interaction between prothrombotic factors and atherosclerosis, or as yet undiscovered risk factors. Full-Text PDF
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Levy et al. (2000) conducted an editorial in Cardiovascular disease. South Asian ethnicity vs. European and Chinese ethnicity was evaluated on Cardiovascular disease rates. South Asian ethnicity is associated with higher rates of cardiovascular disease compared with Europeans and Chinese, which is only partly explained by conventional risk factors and atherosclerosis.
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