Papers

Comparison of case fatality in south Asian and white patients after acute myocardial infarction: observational study

^a Environmental Epidemiology Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT, ^b Department of Cardiology, London Chest Hospital, London, ^c Departments of Cardiology and Diabetes, Newham General Hospital, London

Correspondence to: Dr Wilkinson.

Abstract

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.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

This article has been cited by other articles:

• Agyemang, C, Vaartjes, I, Bots, M L, van Valkengoed, I G, de Munter, J S, de Bruin, A, Berger-van Sijl, M, Reitsma, J B, Stronks, K (2009). Risk of death after first admission for cardiovascular diseases by country of birth in The Netherlands: a nationwide record-linked retrospective cohort study. Heart 95: 747-753 [Abstract] [Full text]  
• Mathews, R., Zachariah, R. (2008). Coronary Heart Disease in South Asian Immigrants: Synthesis of Research and Implications for Health Promotion and Prevention in Nursing Practice. J Transcult Nurs 19: 292-299 [Abstract]  
• Wild, S.H., Fischbacher, C., Brock, A., Griffiths, C., Bhopal, R. (2007). Mortality from all causes and circulatory disease by country of birth in England and Wales 2001-2003. J Public Health (Oxf) 29: 191-198 [Abstract] [Full text]  
• Teoh, M., Lalondrelle, S., Roughton, M., Grocott-Mason, R., Dubrey, S. W (2007). Acute coronary syndromes and their presentation in Asian and Caucasian patients in Britain. Heart 93: 183-188 [Abstract] [Full text]  
• Liew, R, Sulfi, S, Ranjadayalan, K, Cooper, J, Timmis, A D (2006). Declining case fatality rates for acute myocardial infarction in South Asian and white patients in the past 15 years. Heart 92: 1030-1034 [Abstract] [Full text]  
• Zindrou, D., Taylor, K. M., Bagger, J. P. (2006). Coronary artery size and disease in UK South Asian and Caucasian men.. Eur. J. Cardiothorac. Surg. 29: 492-495 [Abstract] [Full text]  
• Graham, J J, Timmis, A, Cooper, J, Ramdany, S, Deaner, A, Ranjadayalan, K, Knight, C (2006). Impact of the National Service Framework for coronary heart disease on treatment and outcome of patients with acute coronary syndromes. Heart 92: 301-306 [Abstract] [Full text]  
• Mukhopadhyay, B., Sattar, N., Fisher, M. (2005). Review: Diabetes and cardiac disease in South Asians. British Journal of Diabetes & Vascular Disease 5: 253-259 [Abstract]  
• Britton, A., Shipley, M., Marmot, M., Hemingway, H. (2004). Does access to cardiac investigation and treatment contribute to social and ethnic differences in coronary heart disease? Whitehall II prospective cohort study. BMJ 329: 318- [Abstract] [Full text]  
• Kain, K., Catto, A. J (2002). Insulin resistance syndrome in South Asians. British Journal of Diabetes & Vascular Disease 2: 398-402 [Abstract]  
• Gupta, M., Doobay, A. V., Singh, N., Anand, S. S., Raja, F., Mawji, F., Kho, J., Karavetian, A., Yi, Q., Yusuf, S. (2002). Risk factors, hospital management and outcomes after acute myocardial infarction in South Asian Canadians and matched control subjects. CMAJ 166: 717-722 [Abstract] [Full text]  
• CHAMBERS, J. C, KOONER, J. S (2001). Homocysteine: a novel risk factor for coronary heart disease in UK Indian Asians. Heart 86: 121-122 [Full text]  
• Barakat, K, Stevenson, S, Wilkinson, P, Suliman, A, Ranjadayalan, K, Timmis, A D (2001). Socioeconomic differentials in recurrent ischaemia and mortality after acute myocardial infarction. Heart 85: 390-394 [Abstract] [Full text]  
• KOONER, J. S (1997). Coronary heart disease in UK Indian Asians: the potential for reducing mortality. Heart 78: 530-532 [Full text]  
• White, M., Sayer, J. W, Timmis, A. D, Wilkinson, P., Smith, B S, Choudhury, R. P, Ramrakha, P. S, Shaukat, N, de Bono, D P (1997). First myocardial infarction in patients of Indian subcontinent and European origin. BMJ 315: 118-118 [Full text]  
• Shaukat, N, Lear, J, Lowy, A, Fletcher, S, de Bono, D P, Woods, K L (1997). First myocardial infarction in patients of Indian subcontinent and European origin: comparison of risk factors, management, and long term outcome. BMJ 314: 639-639 [Abstract] [Full text]  
• Maxwell, J D, Strachan, D P (1996). Risk of coronary heart disease in Hindus and Muslims from Indian subcontinent is similar. BMJ 313: 563a-563 [Full text]