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  3. Heterogeneity of coronary heart disease risk factors in Indian, Pakistani, Bangladeshi, and European origin populations: cross sectional study
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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: https://doi.org/10.1136/bmj.319.7204.215 (Published 24 July 1999) Cite this as: BMJ 1999;319:215

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aculturation

Fascinating paper. The work in Newcastle is most interesting. I was wondering if there were measures of aculturation and the relationship of acculturation to risk factors. It would seem that the asian group would range from those who maintain almost pure asian tradition to those who are indistinguishable from the traditional english group.

Competing interests: No competing interests

28 July 1999
Ronald Laporte
professor
epidemiologist

RISK FACTORS MISSED; QUESTIONS REMAIN

The first Key Message of the study by Bhopal et als (BMJ; 319, 1999:
215-22) is: "South Asians have more coronary heart disease [CHD] than
Europeans despite apparently lower levels of risk factors". This
statement is a telling comment about the relevance of today's standard
risk factors, including total and LDL cholesterol.

It is unfortunate for example that the only nutritional aspects
considered were "daily fruit and vegetable" and alcohol consumption. No
factors such as supplement use or the consumption of trans fatty acids or
omega-3 containing foods were included.

Furthermore, with the probably protective role of supplemented
vitamin E and the probably detrimental role of homocysteine, important
confounding risk factors were not included. I note for example that risk
factor homocysteine increases by a low vitamin B content of processed
grains or by a low vitamin B12 content of vegetarian foods, but that it is
rapidly lowered by supplemented B-vitamins and by the unprocessed grain
component betaine.

This study despite its scope did little to shore up the validity of
the currently accepted risk factors and provides little guidance as to the
causes and prevention of CDH, in South Asians, or others.

Competing interests: No competing interests

24 July 1999
Eddie Vos
maintains: www.health-heart.org
Glen Sutton Qc Canada
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