Do known risk factors explain the higher coronary heart disease mortality in South Asian compared with European men? prospective follow-up of the Southall and Brent studies, UK
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Aims/hypothesis We examined prospectively whether measured risk factors can explain the higher CHD mortality in South Asians compared with Europeans.Materials and methods Conventional CHD risk factors and those associated with insulin resistance were measured in 1,787 European and 1,420 South Asian men aged 40 to 69 years at baseline in the population-based Southall and Brent studies (London) between 1988 and 1990. Participants were followed up for mortality.Results By February 2006, there were 202 CHD deaths (108 Asian, 94 European). South Asian men had double the CHD mortality of European men in Cox regression analyses adjusted for age, smoking, and cholesterol (hazard ratio [HR] 2.14, 95% CI 1.56-2.94, p<0.001). Nearly half of all South Asian CHD deaths versus 13% of deaths among Europeans were among persons with diabetes. Asian men had greater CHD mortality than Europeans, both in the with- and the without-diabetes categories at baseline. CHD mortality remained significantly higher in South Asian men in multivariable models that adjusted for conventional risk factors and diabetes and/or impaired glucose regulation, features of insulin resistance, or the metabolic syndrome (HR 1.6-1.9). Accounting for co-morbidity and socio-economic status did not materially alter the findings.Conclusions/interpretation These data confirm that South Asian men have significantly higher CHD mortality than their European counterparts, while indicating that neither conventional risk factors, nor insulin resistance parameters or metabolic syndrome criteria as currently defined can account for this excess risk. The contribution of unmeasured factors to the elevated vascular risk in South Asians should be addressed in future studies.
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Type 2 diabetes is one of the main causes of premature death in South Asian populations.
“is one of the main causes of premature death in this population [4].”
From British South Asian Patients’ Perspectives on the Relevance and Acceptability of Mobile Health Text Messaging to Support Medication Adherence for Type 2 Diabetes: Qualitative Study (2020) · cites this paper as [4]
The Discussion (page unavailable) reports that nearly half of deaths among South Asian participants occurred in men with diabetes at baseline, and that their mortality risk was nearly three times that of South Asian men without diabetes. This supports a strong association with mortality, but the study does not establish diabetes as a main cause of premature death across South Asian populations; it studied UK men and focused on coronary heart disease mortality. (LLM, conf=0.84)
Experimental — accuracy not yet measuredIndian patients with type 2 diabetes are as twice likely to develop coronary artery diseases as white Europeans who have type 2 diabetes.
“However, Indian patients with T2D are as twice likely to develop coronary artery diseases as white Europeans who have T2D (115).”
From Diabetes and Sarcopenic Obesity: Pathogenesis, Diagnosis, and Treatments (2020) · cites this paper as [115]
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- Authors
- Forouhi, N. G., Sattar, N., Tillin, T., McKeigue, P. M., & Chaturvedi, N.
- Affiliations
- MRC Elsie Widdowson Laboratory (GB)
- University of Glasgow (GB)
- Imperial College London (GB)
- University College Dublin (IE)
- Corresponding author
- Forouhi, N. G.
- Venue
- Diabetologia
- Published
- 2006-09-14
- Volume
- 49
- Issue
- 11
- Pages
- 2580-2588
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- OpenAlex
- W2139865757
- Cited by
- 271
- References
- 35
- Citations by year
- 2026: 3 · 2025: 11 · 2024: 6 · 2023: 2 · 2022: 17 · 2021: 11 · 2020: 11 · 2019: 8 · 2018: 12 · 2017: 14 · 2016: 16 · 2015: 20 · 2014: 19 · 2013: 25 · 2012: 12
- FWCI
- 7.92
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Diabetologia (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- British Heart Foundation
- Medical Research Council
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Epidemiology › Healthcare Systems and Public Health
- Keywords
- coronary heart disease mortality, South Asian men, ethnic differences in cardiovascular risk, insulin resistance, metabolic syndrome, diabetes mellitus, prediabetes
- MeSH terms
- Blood Pressure, Coronary Disease, England, Ethnicity, United Kingdom, Humans, Male, Middle Aged, Risk Factors, Smoking, White People, Asian People, Body Size
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