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

BMJ 1999; 319 doi: (Published 24 July 1999) Cite this as: BMJ 1999;319:215

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  1. Raj Bhopal, professor (Raj.Bhopal{at},
  2. Nigel Unwin, senior lecturer in epidemiologyb,
  3. Martin White, senior lecturer in public health medicinea,
  4. Julie Yallop, research associateb,
  5. Louise Walker, research associateb,
  6. K G M M Alberti, professorc,
  7. Jane Harland, research associateb,
  8. Sheila Patel, research associateb,
  9. Naseer Ahmad, research associateb,
  10. Catherine Turner, research nurseb,
  11. Bill Watson, research associateb,
  12. Dalvir Kaur, study administratorb,
  13. Anna Kulkarni, research nurseb,
  14. Mike Laker, readerd,
  15. Anna Tavridou, PhD studentd
  1. a Department of Epidemiology and Public Health, Medical School, University of Newcastle, Newcastle upon Tyne NE2 4HH
  2. b Departments of Medicine and Epidemiology and Public Health, Wellcome Laboratories, Royal Victoria Infirmary, Newcastle upon Tyne
  3. c Department of Medicine, Medical School, University of Newcastle
  4. d Department of Clinical Biochemistry, Medical School, University of Newcastle
  1. Correspondence to: R Bhopal Public Health Sciences, Medical School, Edinburgh EH8 9AG
  • Accepted 28 April 1999


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


  • Funding Barclay Trust, British Diabetic Association, Newcastle Health Authority, research and development directorate of the Northern Regional Health Authority, Department of Health, and British Heart Foundation.

  • Competing interests None declared.

  • website extra A longer version of this paper is available on the BMJ's website

  • Accepted 28 April 1999
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