BMJ 1999;319:215-220 ( 24 July )

Papers

Heterogeneity of coronary heart disease risk factors in Indian, Pakistani, Bangladeshi, and European origin populations: cross sectional study

Raj Bhopal, professor, a Nigel Unwin, senior lecturer in epidemiology, b Martin White, senior lecturer in public health medicine, a Julie Yallop, research associate, b Louise Walker, research associate, b K G M M Alberti, professor, c Jane Harland, research associate, b Sheila Patel, research associate, b Naseer Ahmad, research associate, b Catherine Turner, research nurse, b Bill Watson, research associate, b Dalvir Kaur, study administrator, b Anna Kulkarni, research nurse, b Mike Laker, reader, d Anna Tavridou, PhD student. d

a Department of Epidemiology and Public Health, Medical School, University of Newcastle, Newcastle upon Tyne NE2 4HH, b Departments of Medicine and Epidemiology and Public Health, Wellcome Laboratories, Royal Victoria Infirmary, Newcastle upon Tyne, c Department of Medicine, Medical School, University of Newcastle, d Department of Clinical Biochemistry, Medical School, University of Newcastle

Correspondence to: R Bhopal Public Health Sciences, Medical School, Edinburgh EH8 9AG Raj.Bhopal{at}ed.ac.uk

Objective: To compare coronary risk factors and disease prevalence among Indians, Pakistanis, and Bangladeshis, and in all South Asians (these three groups together) with Europeans.
Design: Cross sectional survey.
Setting: Newcastle upon Tyne.
Participants: 259 Indian, 305 Pakistani, 120 Bangladeshi, and 825 European men and women aged 25-74 years.
Main outcome measures: Social and economic circumstances, lifestyle, self reported symptoms and diseases, blood pressure, electrocardiogram, and anthropometric, haematological, and biochemical measurements.
Results: There were differences in social and economic circumstances, lifestyles, anthropometric measures and disease both between Indians, Pakistanis, and Bangladeshis and between all South Asians and Europeans. Bangladeshis and Pakistanis were the poorest groups. For most risk factors, the Bangladeshis (particularly men) fared the worst: smoking was most common (57%) in that group, and Bangladeshis had the highest concentrations of triglycerides (2.04 mmol/l) and fasting blood glucose (6.6 mmol/l) and the lowest concentration of high density lipoprotein cholesterol (0.97 mmol/l). Blood pressure, however, was lowest in Bangladeshis. Bangladeshis were the shortest (men 164 cm tall v 170 cm for Indians and 174 cm for Europeans). A higher proportion of Pakistani and Bangladeshi men had diabetes (22.4% and 26.6% respectively) than Indians (15.2%). Comparisons of all South Asians with Europeans hid some important differences, but South Asians were still disadvantaged in a wide range of risk factors. Findings in women were similar.
Conclusion: Risk of coronary heart disease is not uniform among South Asians, and there are important differences between Indians, Pakistanis, and Bangladeshis for many coronary risk factors. The belief that, except for insulin resistance, South Asians have lower levels of coronary risk factors than Europeans is incorrect, and may have arisen from combining ethnic subgroups and examining a narrow range of factors.


Key messages

  • South Asians have more coronary heart disease than Europeans despite apparently lower levels of risk factors

  • This study shows that Indians, Pakistanis and Bangladeshis differ in a wide range of coronary risk factors and combining their data is misleading

  • Among South Asians, Indians were least and Bangladeshis most disadvantaged in a range of coronary risk factors. South Asians were disadvantaged in comparison with Europeans

  • Future research and prevention strategies for coronary heart disease in South Asians should acknowledge a broad range of risk factors, the heterogeneity of these populations, linguistic and cultural needs, and environmental factors




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