Prevention must start in childhood

Papers p 635

People with ancestry in the countries of the Indian subcontinent (South Asians), comprising more than one fifth of the global population, are highly susceptible to cardiovascular diseases. This susceptibility is well demonstrated in South Asian migrants in places as diverse as the United Kingdom, South Africa, the Caribbean, Singapore, the United States, Canada, and urban India.1 Unless controlled, this epidemic, which is starting in urban settings but spreading rapidly to semi-urban and rural settings, will thwart global control of cardiovascular diseases.2 Research on several communities of the South Asian diaspora has provided insights that are vital to the control of cardiovascular diseases in South Asians worldwide. In this issue Whincup et al extend the strong tradition of British research by reporting observations in children (p 635).3

In 1994 Whincup et al measured insulin, glucose, and other biochemical risk factors and made social and anthropometric observations in 8-11 year olds, mostly Pakistani Muslims, in 10 British towns. Their work primarily contributes to two questions. Firstly, what is the potential role of insulin resistance in explaining the high risk of cardiovascular diseases in South Asians. Secondly, given a particular exposure to a risk factor, might South Asians be at higher risk or more susceptible to its effects?

The causes of the high cardiovascular risk …