Excess coronary heart disease in South Asians in the United Kingdom

The problem has been highlighted, but much more needs to be done

Health inequality between ethnic groups in the United Kingdom is widening.1 Death rates from coronary heart disease in South Asians (immigrants from India, Pakistan, Bangladesh, and Sri Lanka) have declined at a slower rate than in the indigenous population.2 Accumulating evidence shows that second and third generation South Asians seem to be displaying many of the same risk characteristics that make them prone to coronary heart disease as their parents and grandparents.3 The first published evidence of elevated risk of coronary heart disease in South Asians appeared as early as 1959—from a study based on expatriate Indians in Singapore.^w1 Numerous subsequent studies corroborated the findings. However, the topic of ethnicity and disparities in outcomes from coronary heart disease in the United Kingdom has only recently been given the importance it deserves.^w2

We still do not have an explanation for excess deaths from coronary heart disease in South Asians, but several plausible hypotheses have been generated (box).^{w3 w4} The increased prevalence of the metabolic syndrome (comprising insulin resistance, hypertension, central obesity, and hyperlipidaemia) and diabetes mellitus in this population is the most convincing and consistent explanation to date.^w3 None of the hypotheses has been studied systematically, and current understanding …