Cardiovascular disease in South Asians: A burgeoning epidemic
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Corresponding author Vikram V. Kamdar, MD Division of Endocrinology, David Geffen School of Medicine at UCLA, 1801 Wilshire Boulevard, Santa Monica, CA 90402, USA. E-mail: [email protected] Current Cardiovascular Risk Reports 2008, 2:187–191 Current Medicine Group LLC ISSN 1932-9520 Copyright © 2008 by Current Medicine Group LLC
Both native and expatriate South Asians have high levels of coronary artery disease. The most important factors contributing to this situation are the increased prevalences of obesity, metabolic syndrome, and diabetes in developing countries. Traditional risk factors are less relevant in South Asians. Understanding the ethnic-specific factors important in risk of coronary artery disease and effective therapies in this population is essential to be able to resolve ethnic differences in cardiovascular disease.
Introduction In the year 2000, 16.7 million people died of cardiovascular disease (CVD) worldwide, and 30.3% of them were in developing nations, of which South Asia represents more than a quarter. South Asia is usually considered as comprising Bangladesh, Bhutan, India, Nepal, Pakistan, and Sri Lanka. Of the 4.1% of the US population of Asian descent, 16% are of South Asian Indian ancestry, which is the fastest growing population in the United States. South Asians have high levels of coronary artery disease (CAD) in natives [1–3] and expatriates [4, 5 ]. The most important factors contributing to this shift are the increased prevalences of obesity, metabolic syndrome, and diabetes in developing countries, which are a result of increasing urbanization, industrialization, and energy consumption in the form of concentrated calories and fat. Other factors are increased salt consumption and psychological stress from acculturation and migration. Unfortunately, despite the long shadow CAD casts on South Asians, insufficient research exists regarding alternate thresholds for prevention and early management of CAD. This article describes unique features of CAD
development in South Asians, highlighting issues to be considered in managing a South Asian patient.
Epidemiology in South Asians and Asian Indians Since the 1950s, there has been an increased awareness that people with ancestral origins in the Indian subcontinent are highly susceptible to CVD, especially after moving to urban environments [6]. Balarajan et al. [7 ] found that the standard mortality ratio was higher for men born in South Asia than for other ethnic groups living in England and Wales. There was a decline in mortality due to CAD in all the ethnic groups except South Asian Indians, whose mortality rate had risen (6% in men and 13% in women) between 1970–1972 and 1979–1983. Although data are limited, existing data support a higher prevalence of CAD and increased CAD mortality in South Asians versus others living in the United States. The prevalence of CAD in Asian Indian physicians is three to four times higher than that of the general physician population of the United States [8]. South Asians account for 25% of death
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