Intended for healthcare professionals


Excess coronary heart disease in South Asians in the United Kingdom

BMJ 2005; 330 doi: (Published 26 May 2005) Cite this as: BMJ 2005;330:1223

CHD in South Asians, it's the homocysteine (micro-nutrients), stupid!

To its credit, the editorial lists high homocysteine (Hcy) as risk factor
for greater incidence of coronary heart disease (CHD) in South Asians.
This alarming situation is illustrated by Misra
et al
(1) in healthy young adults in New Delhi with Hcy levels
of ~22 µmol/L, slum-dwellers, non-vegetarians and women doing
numerically but marginally better.

An astounding 95% of the sample consumed less than the recommended amount
of folic acid and ~82% were insufficient for vitamin B12; the third of
the main Hcy-lowering micronutrients, vitamin B6, was not measured [vitamin
B2, betaine, copper, zinc and magnesium also play roles, while generally
getting older and smoking raises Hcy].

To put this level of 22 µmol/L into context, that is the level
found in over 90 year olds in Framingham (U.S.) and in elderly depending
upon home delivered food in Rotterdam (Netherlands); it represents gross
that for pennies a year could be aided by
food fortification. Hcy at 22 µmol/L is 3x above the level at which
CVD is exceptionally low and arguably a life long target in primary prevention.

A final player in excess CHD could be the switch away from the traditional
mustard seed oil in South Asia which, like its 'sister', canola (rape /
colza) oil, is an exceptional source of plant based omega-3 fatty acid,
and of demonstrated CHD benefit as per the 'Lyon'
(2) and 'Indo-Med'
(3) studies. vos{at}

1.) Misra A, Vikram NK, Pandey RM, Dwivedi M, Ahmad FU, Luthra K et
al. Hyperhomocysteinemia,
and low intakes of folic acid and vitamin B12 in urban North India.

Eur J Nutr. 2002 Apr;41(2):68-77. Medline: 12083316

2.) Leaf A. Dietary
Prevention of Coronary Heart Disease. The Lyon diet Heart Study.
1999;99:733-735. Medline 9989956

3.) Singh RB, Dubnov G, Niaz MA, Ghosh S, Singh R, Rastogi SS et al
of an Indo-Mediterranean diet on progression of coronary artery disease
in high risk patients (Indo-Mediterranean Diet Heart Study): a randomised
single-blind trial.
Lancet. 2002 Nov 9;360(9344):1455-61. Medline 12433513

Competing interests:
None declared

Competing interests: No competing interests

29 May 2005
Eddie Vos
Sutton (Qc) Canada J0E 2K0