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Singh V, Dhamoon MS, Alladi S. Stroke Risk and Vascular Dementia in South Asians. Curr Atheroscler Rep 2018; 20:43. [DOI: 10.1007/s11883-018-0745-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Singh V, Prabhakaran S, Chaturvedi S, Singhal A, Pandian J. An Examination of Stroke Risk and Burden in South Asians. J Stroke Cerebrovasc Dis 2017; 26:2145-2153. [PMID: 28579510 DOI: 10.1016/j.jstrokecerebrovasdis.2017.04.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 04/12/2017] [Accepted: 04/29/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND South Asians (India, Pakistan, Sri Lanka, Bangladesh, Nepal, and Bhutan) are at a disproportionately higher risk of stroke and heart disease due to their cardiometabolic profile. Despite evidence for a strong association between diabetes and stroke, and growing stroke risk in this ethnic minority-notwithstanding reports of higher stroke mortality irrespective of country of residence-the explanation for the excess risk of stroke remains unknown. METHODS We have used extensive literature review, epidemiologic studies, morbidity and mortality records, and expert opinions to examine the burden of stroke among South Asians, and the risk factors identified thus far. RESULTS We summarize existing evidence and indicate gaps in current knowledge of stroke epidemiology among South Asian natives and immigrants. CONCLUSIONS This research focuses attention on a looming epidemic of stroke mainly due to modifiable risk factors, but also new determinants that might aggravate the effect of vascular risk factors in South Asians causing more disabling strokes and death.
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Affiliation(s)
- Vineeta Singh
- Department of Neurology, University of California San Francisco, San Francisco, California.
| | | | - Seemant Chaturvedi
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida
| | - Aneesh Singhal
- Department of Neurology, Harvard Medical School, Boston, Massachusetts
| | - Jeyaraj Pandian
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
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Das A, Ambale-Venkatesh B, Lima JAC, Freedman JE, Spahillari A, Das R, Das S, Shah RV, Murthy VL. Cardiometabolic disease in South Asians: A global health concern in an expanding population. Nutr Metab Cardiovasc Dis 2017; 27:32-40. [PMID: 27612985 DOI: 10.1016/j.numecd.2016.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/30/2016] [Accepted: 08/01/2016] [Indexed: 12/27/2022]
Abstract
Cardiovascular disease (CVD) is one of the main causes of mortality and morbidity worldwide. As an emerging population, South Asians (SAs) bear a disproportionately high burden of CVD relative to underlying classical risk factors, partly attributable to a greater prevalence of insulin resistance and diabetes and distinct genetic and epigenetic influences. While the phenotypic distinctions between SAs and other ethnicities in CVD risk are becoming increasingly clear, the biology of these conditions remains an area of active investigation, with emerging studies involving metabolism, genetic variation and epigenetic modifiers (e.g., extracellular RNA). In this review, we describe the current literature on prevalence, prognosis and CVD risk in SAs, and provide a landscape of translational research in this field toward ameliorating CVD risk in SAs.
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Affiliation(s)
- A Das
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - B Ambale-Venkatesh
- Department of Medicine and Cardiology, Heart and Vascular Institute, Johns Hopkins Medical Institutions, The Johns Hopkins University, Baltimore, USA
| | - J A C Lima
- Department of Medicine and Cardiology, Heart and Vascular Institute, Johns Hopkins Medical Institutions, The Johns Hopkins University, Baltimore, USA
| | - J E Freedman
- Department of Cardiology, UMass Memorial Health Care, MA, USA
| | - A Spahillari
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - R Das
- The John Hopkins University, Baltimore, USA
| | - S Das
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - R V Shah
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - V L Murthy
- Cardiovascular Medicine Division, Department of Medicine, University of Michigan, Ann Arbor, USA.
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Hemingway H, Feder GS, Fitzpatrick NK, Denaxas S, Shah AD, Timmis AD. Using nationwide ‘big data’ from linked electronic health records to help improve outcomes in cardiovascular diseases: 33 studies using methods from epidemiology, informatics, economics and social science in the ClinicAl disease research using LInked Bespoke studies and Electronic health Records (CALIBER) programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05040] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BackgroundElectronic health records (EHRs), when linked across primary and secondary care and curated for research use, have the potential to improve our understanding of care quality and outcomes.ObjectiveTo evaluate new opportunities arising from linked EHRs for improving quality of care and outcomes for patients at risk of or with coronary disease across the patient journey.DesignEpidemiological cohort, health informatics, health economics and ethnographic approaches were used.Setting230 NHS hospitals and 226 general practices in England and Wales.ParticipantsUp to 2 million initially healthy adults, 100,000 people with stable coronary artery disease (SCAD) and up to 300,000 patients with acute coronary syndrome.Main outcome measuresQuality of care, fatal and non-fatal cardiovascular disease (CVD) events.Data platform and methodsWe created a novel research platform [ClinicAl disease research using LInked Bespoke studies and Electronic health Records (CALIBER)] based on linkage of four major sources of EHR data in primary care and national registries. We carried out 33 complementary studies within the CALIBER framework. We developed a web-based clinical decision support system (CDSS) in hospital chest pain clinics. We established a novel consented prognostic clinical cohort of SCAD patients.ResultsCALIBER was successfully established as a valid research platform based on linked EHR data in nearly 2 million adults with > 600 EHR phenotypes implemented on the web portal (seehttps://caliberresearch.org/portal). Despite national guidance, key opportunities for investigation and treatment were missed across the patient journey, resulting in a worse prognosis for patients in the UK compared with patients in health systems in other countries. Our novel, contemporary, high-resolution studies showed heterogeneous associations for CVD risk factors across CVDs. The CDSS did not alter the decision-making behaviour of clinicians in chest pain clinics. Prognostic models using real-world data validly discriminated risk of death and events, and were used in cost-effectiveness decision models.ConclusionsEmerging ‘big data’ opportunities arising from the linkage of records at different stages of a patient’s journey are vital to the generation of actionable insights into the diagnosis, risk stratification and cost-effective treatment of people at risk of, or with, CVD.Future workThe vast majority of NHS data remain inaccessible to research and this hampers efforts to improve efficiency and quality of care and to drive innovation. We propose three priority directions for further research. First, there is an urgent need to ‘unlock’ more detailed data within hospitals for the scale of the UK’s 65 million population. Second, there is a need for scaled approaches to using EHRs to design and carry out trials, and interpret the implementation of trial results. Third, large-scale, disease agnostic genetic and biological collections linked to such EHRs are required in order to deliver precision medicine and to innovate discovery.Study registrationCALIBER studies are registered as follows: study 2 – NCT01569139, study 4 – NCT02176174 and NCT01164371, study 5 – NCT01163513, studies 6 and 7 – NCT01804439, study 8 – NCT02285322, and studies 26–29 – NCT01162187. Optimising the Management of Angina is registered as Current Controlled Trials ISRCTN54381840.FundingThe National Institute for Health Research (NIHR) Programme Grants for Applied Research programme (RP-PG-0407-10314) (all 33 studies) and additional funding from the Wellcome Trust (study 1), Medical Research Council Partnership grant (study 3), Servier (study 16), NIHR Research Methods Fellowship funding (study 19) and NIHR Research for Patient Benefit (study 33).
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Affiliation(s)
- Harry Hemingway
- Institute of Health Informatics, University College London, London, UK
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Gene S Feder
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Natalie K Fitzpatrick
- Institute of Health Informatics, University College London, London, UK
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Anoop D Shah
- Institute of Health Informatics, University College London, London, UK
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Adam D Timmis
- Farr Institute of Health Informatics Research, University College London, London, UK
- Barts Health NHS Trust, London, UK
- Farr Institute of Health Informatics Research, Queen Mary University of London, London, UK
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Affiliation(s)
- Kirti Kain
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9JT, UK.
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Patel JV, Banerjee A, Montoro-Garcia S, Shantsila E, Alam M, Flinders P, Houlton KAL, Hughes EA, Lip GYH, Gill PS. CD36 expression and lipid metabolism following an oral glucose challenge in South Asians. World J Diabetes 2015; 6:983-989. [PMID: 26185606 PMCID: PMC4499532 DOI: 10.4239/wjd.v6.i7.983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 04/03/2015] [Accepted: 05/06/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To investigate lipid metabolism and the relationship with monocyte expression of the fatty acid translocase CD36 in South Asians.
METHODS: An observational study of South Asians whom as an ethnic group have - a higher risk of developing diabetes. The susceptibility to diabetes is coupled with an earlier and more rapid progression of micro-, and macro-vascular complications. Twenty-nine healthy South Asian participants [mean age 34.6 (8.9) years, 76.2% male, mean body-mass index 25.0 (5.2) kg/m2] were recruited from an urban residential area of central Birmingham (United Kingdom). The main outcomes measured were post prandial (30 min) and post absorptive (120 min) changes from fasting (0 min) in circulating lipoproteins, lipds and hormones, and monocyte expression of CD36 post injection of a 75 g oral glucose challenge. The inducements of variations of monocyte CD36 expression were analysed.
RESULTS: Our results showed evident changes in monocyte CD36 expression following the glucose challenge (P < 0.001). Non-esterified fatty acids (NEFA) levels decreased progressively during the challenge (P < 0.001), in contrast to increased cholesterol (but not triglyceride) concentrations within very low density lipoprotein (VLDL) and low density lipoprotein subfractions (P < 0.01). Levels of, glucose, serum triglycerides and high density lipoprotein cholesterol remained largely unchanged. Variations of monocyte CD36 were negatively (r = -0.47, P = 0.04) associated to fat from the diet and positively to carbohydrate from the diet (r = 0.65, P < 0.001).
CONCLUSION: These data suggest that the initiation of VLDL genesis follows the consumption of glucose within this population, inferring that the sequestration of NEFA from these particles happens due to the increased availability of CD36 receptors. While these are preliminary results, it would appear that lifestyle exposures have a role in moderating the expression of CD36.
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Fernando E, Razak F, Lear SA, Anand SS. Cardiovascular Disease in South Asian Migrants. Can J Cardiol 2015; 31:1139-50. [PMID: 26321436 DOI: 10.1016/j.cjca.2015.06.008] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 06/11/2015] [Accepted: 06/11/2015] [Indexed: 02/09/2023] Open
Abstract
Cardiovascular disease (CVD) represents a significant cause of global mortality and morbidity. South Asians (SAs) have a particularly high burden of coronary artery disease (CAD). This review describes current literature regarding the prevalence, incidence, etiology, and prognosis of CVD in SA migrants to high-income nations. We conducted a narrative review of CVD in the SA diaspora through a search of MEDLINE and PubMed. We included observational studies, randomized clinical trials, nonsystematic reviews, systematic reviews, and meta-analyses written in English. Of 15,231 articles identified, 827 articles were screened and 124 formed the basis for review. SA migrants have a 1.5-2 times greater prevalence of CAD than age- and sex-adjusted Europids. Increased abdominal obesity and body fat and increased burden of type 2 diabetes mellitus and dyslipidemia appear to be primary drivers of the excess CAD burden in SAs. Sedentary lifestyle and changes in diet after immigration are important contributors to weight gain and adiposity. Early life factors, physical activity patterns and, in some cases, reduced adherence to medical therapy may contribute to increased CVD risks in SAs. Novel biomarkers like leptin and adipokines may show distinct patterns in SAs and provide insights into cardiometabolic risk determinants. In conclusion, SAs have distinct CVD risk predispositions, with a complex relationship to cultural, innate, and acquired factors. Although CVD risk factor management and treatment among SAs is improving, opportunities exist for further advances.
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Affiliation(s)
- Eshan Fernando
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Fahad Razak
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada; Harvard Center for Population and Development Studies, Boston, Massachusetts, USA
| | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; Division of Cardiology, Providence Health Care, Vancouver, British Columbia, Canada
| | - Sonia S Anand
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Epidemiology, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada; Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada.
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Gill PS, Patel JV, Chackathayil J, Webster C, Davis RC, Hughes E, Lip GYH. Subclinical thyroid dysfunction and cardiac function amongst minority ethnic groups in the UK: a cross sectional study. Int J Cardiol 2013; 168:5218-20. [PMID: 23993730 DOI: 10.1016/j.ijcard.2013.08.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 08/03/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Subclinical thyroid disease is associated with abnormal cardiovascular haemodynamics and increased risk of heart failure. The burden of raised/low thyroid stimulating hormone (TSH) levels amongst South Asian (SA) and African-Caribbean (AC) minority groups in the UK is not well defined. Given that these groups are particularly susceptible to CVD, we hypothesised that STD would reflect abnormal cardiac function and heightened cardiovascular risk in these ethnic groups. METHODS We examined SA (n=1111, 56% male, mean age 57.6 yrs) and AC (n=763, 44% male, mean age 59.2 yrs) participants from a large heart failure screening study. Euthyroidism is defined as TSH (0.4 - 4.9 mlU/l), subclinical hypothyroidism is defined as a raised TSH with normal serum free thyroxine (FT4) concentrations (9-19 pmol/l). Subclinical hyperthyroidism is defined as a low TSH with both FT4 and free triiodothyronine (FT3) concentrations within range (2.6-5.7 pmol/l). RESULTS Across ethnic groups, prevalence of subclinical hypothyroidism was 2.9% (95% CI 2.1-3.7), and of hyperthyroidism was 2.0% (1.4-2.7). Hyperthyroidism was more common amongst SA compared to AC (2.8% vs. 0.9%, P=0.017), while rates of subclinical hypothyroidism were similar. On multivariate analysis of variations in subclinical thyroid function, ethnicity was not independently significant. CONCLUSION The prevalence of subclinical thyroid disorders amongst SA and AC minority groups in Britain reflects levels reported in other populations. The clinical cardiovascular significance of subclinical thyroid disease is unclear, and it does not appear to be ethnically specific.
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Affiliation(s)
- Paramjit S Gill
- Primary Care Clinical Sciences, University of Birmingham, UK.
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Zaman MJS, Philipson P, Chen R, Farag A, Shipley M, Marmot MG, Timmis AD, Hemingway H. South Asians and coronary disease: is there discordance between effects on incidence and prognosis? Heart 2013; 99:729-36. [PMID: 23406688 PMCID: PMC3960593 DOI: 10.1136/heartjnl-2012-302925] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Objective To determine whether the effect of South Asian ethnicity differs between studies of incidence and prognosis of coronary disease. Design Systematic literature review and meta-analysis, and cohort analysis from a national acute coronary syndrome (ACS) registry linked to mortality (National Institute of Cardiovascular Outcomes Research/Myocardial Infarction National Audit Project). Setting International for the review, and England and Wales for the cohort analysis. Patients The numbers of South Asians included in the meta-analysis were 111 555 (incidence) and 14 531 (prognosis) of whom 8251 were from the ACS cohort. Main outcome measures Incidence studies: non-fatal myocardial infarction or fatal coronary heart disease; prognostic studies: mortality; HRs for 1-year all-cause death in ACS cohort. Results South Asians had higher incidence of coronary disease compared with white subjects (HR 1.35 95% CI 1.30 to 1.40) based on meta-analysis of nine studies. Among 10 studies on prognosis, South Asians had better prognosis compared with white subjects (HR 0.78 95% CI 0.74 to 0.82). In the ACS cohort, the impact of diabetes (42.4% of South Asians, 16.9% of white subjects) on 1-year mortality was stronger in South Asians than white subjects (age-adjusted HR 1.83 95% CI 1.59 to 2.11 vs 1.53 95% CI 1.49 to 1.57). However, prognosis was better in South Asians even among diabetics, older people and those living in areas of the highest social deprivation. Conclusions South Asian ethnicity is associated with higher incidence of coronary disease, but lower mortality once coronary disease is manifest. The dissociation between effects on incidence and prognosis suggests that public health initiatives to reduce inequalities in mortality between South Asian and white populations should focus on primary prevention. This is a CALIBER study with ClinicalTrials.gov Identifier: NCT01163513.
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Affiliation(s)
- M Justin S Zaman
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK.
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Chackathayil J, Patel JV, Gill PS, Potluri R, Natalwala A, Uppal H, Lavu D, Heun R, Hughes EA, Lip GYH. Cardiovascular Risk Profiles amongst Women in a Multiethnic Population in Inner City Britain: A Potential Impact of Anaemia. Int J Endocrinol 2013; 2013:303859. [PMID: 23509453 PMCID: PMC3590708 DOI: 10.1155/2013/303859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 12/20/2012] [Accepted: 01/07/2013] [Indexed: 11/17/2022] Open
Abstract
The risk of diabetes is markedly reduced in men with iron deficiency anaemia (IDA). The nature of this relationship in women is not clear, nor is there information about the influence of ethnicity, given the increased susceptibility of diabetes amongst South Asians and Afro-Caribbeans. We reviewed 3563 patients with a diagnosis of anaemia from 2000 to 2007. The age-adjusted prevalence of vitamin B12 deficiency and IDA was calculated, together with cardiovascular comorbidities amongst Caucasians, South Asians, and Afro-Caribbeans. The prevalence of vitamin B12 deficiency (women only) or IDA was markedly higher in South Asians compared to Caucasians and Afro-Caribbeans. Among women with IDA, diabetes was more prevalent among South Asians (45%, 95% CI 39.0-51.0) compared to Caucasians (3.0%, 2.1-4.0); P < 0.001. Among South Asian women with vitamin B12 deficiency, the prevalence of diabetes was reduced 8.5% (5.2-12.0). South Asian women with vitamin B12 deficiency had a higher prevalence of myocardial infarction (MI) and ischemic heart disease (IHD), but this relationship was reversed in IDA. IDA is associated with a greater prevalence of diabetes in South Asian women, but it is not coordinated by a greater risk of macrovascular complications. Given the cardiovascular impact of diabetes in South Asians, this association merits further study in relation to its pathophysiological implication.
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Affiliation(s)
- Julia Chackathayil
- University of Birmingham, Centre for Cardiovascular Sciences, City Hospital, Birmingham B18 7QH and Sandwell Medical Research Unit, Sandwell General Hospital, West Bromwich, West Midlands B71 4HJ, UK
| | - Jeetesh V. Patel
- University of Birmingham, Centre for Cardiovascular Sciences, City Hospital, Birmingham B18 7QH and Sandwell Medical Research Unit, Sandwell General Hospital, West Bromwich, West Midlands B71 4HJ, UK
- *Jeetesh V. Patel:
| | - Paramjit S. Gill
- Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Rahul Potluri
- Department of Cardiovascular Medicine, University of Manchester, Manchester M13 9NT, UK
| | - Ammar Natalwala
- Division of Medical Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Hardeep Uppal
- Division of Medical Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Deepthi Lavu
- Department of Obstetrics and Gynaecology, University Hospital of North Staffordshire, Stoke-on-Trent, UK
| | - Reinhard Heun
- Department of Psychiatry, Derby City General Hospital, Uttoxeter Road, Derby DE22 3NE, UK
| | - Elizabeth A. Hughes
- University of Birmingham, Centre for Cardiovascular Sciences, City Hospital, Birmingham B18 7QH and Sandwell Medical Research Unit, Sandwell General Hospital, West Bromwich, West Midlands B71 4HJ, UK
| | - Gregory Y. H. Lip
- University of Birmingham, Centre for Cardiovascular Sciences, City Hospital, Birmingham B18 7QH and Sandwell Medical Research Unit, Sandwell General Hospital, West Bromwich, West Midlands B71 4HJ, UK
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Patel JV, Chackathayil J, Gammon B, Tracey I, Lovick A, Gill PS, Banerjee A, Scarff CA, Scrivens JH, Lip GY, Hughes EA. Is the higher risk of cardiovascular disease amongst South Asian populations linked to abnormalities of haemoglobin? A preliminary case control study. Atherosclerosis 2013; 226:198-200. [DOI: 10.1016/j.atherosclerosis.2012.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 08/30/2012] [Accepted: 09/15/2012] [Indexed: 11/29/2022]
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Kendall H, Marley A, Patel JV, Khan JM, Blann AD, Lip GYH, Dwivedi G. Hospital delay in South Asian patients with acute ST-elevation myocardial infarction in the UK. Eur J Prev Cardiol 2012; 20:737-42. [DOI: 10.1177/2047487312447844] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Heather Kendall
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK
| | - Alexandra Marley
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK
| | - Jeetesh V Patel
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK
| | - Jawad M Khan
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK
| | - Andrew D Blann
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK
| | - Gregory YH Lip
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK
| | - Girish Dwivedi
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK
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Patel JV, Dodani S, Gill PS. Considerations for equity in cardiovascular healthcare: the South Asian example. Int J Clin Pract 2012; 66:234-7. [PMID: 22340445 DOI: 10.1111/j.1742-1241.2011.02843.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- J V Patel
- Sandwell Medical Research Unit & University of Birmingham Centre for Cardiovascular Sciences, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
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Gholap N, Davies M, Patel K, Sattar N, Khunti K. Type 2 diabetes and cardiovascular disease in South Asians. Prim Care Diabetes 2011; 5:45-56. [PMID: 20869934 DOI: 10.1016/j.pcd.2010.08.002] [Citation(s) in RCA: 146] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 07/26/2010] [Accepted: 08/13/2010] [Indexed: 02/07/2023]
Abstract
Type 2 diabetes (T2DM) is growing at a pandemic scale and is associated with a rapid increase in its complications such as cardiovascular diseases (CVD). This problem is even worse in South Asian population with South Asian people having a much higher prevalence of T2DM and CVD, occurring at an earlier age and being associated with premature and high mortality. This review looks in detail at the current knowledge on epidemiology and characteristic pathophysiology of T2DM and CVD (coronary heart disease, heart failure, stroke and peripheral vascular disease) in South Asian migrant population. Specific attention is also drawn to the role of novel risk factors and cultural and socioeconomic factors on occurrence and outcomes of these chronic diseases in this population. Finally the review makes recommendations on various measures including need for further research to tackle this serious health challenge facing the South Asian community.
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Affiliation(s)
- Nitin Gholap
- Department of Diabetes Research, University Hospitals of Leicester NHS Trust, Leicester, UK.
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Abstract
The role of nutrition is especially important in certain ‘lifestyle’ diseases that impact disproportionately on ethnic minority populations. The aim of this paper is to review the evidence of risk, health outcomes and interventions for certain diseases that affect the UK's largest ethnic minority group (South Asians) in order to help professionals better address the needs of this diverse population. Research evidence is presented on factors influencing access to services by ethnic minority populations and the changing UK policy background for public health and preventive care. The available research base on obesity, diabetes and CVD is discussed. Conditions such as type 2 diabetes, which are more prevalent among the South Asian population, are associated with poorer health outcomes and appear to exhibit links to diet and nutrition that start in childhood or even before birth; all making preventive care important. Obesity is a major risk factor and it appears that BMI thresholds may need to be lower for South Asians. Targeted interventions to improve diet and outcomes in the South Asian population also appear promising. Recent moves to promote access to evidence of ethnicity and health and to improve the cultural competence of organisations are discussed. Health professionals will increasingly need to promote lifestyle changes in a manner that meets the needs of a diverse population in order to address future public health challenges. Nutritionists and other professionals will need to ensure that interventions are culturally appropriate and involve engagement with extended family members and communities.
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Patel JV, Abraheem A, Creamer J, Gunning M, Hughes EA, Lip GY. Apolipoproteins in the discrimination of atherosclerotic burden and cardiac function in patients with stable coronary artery disease. Eur J Heart Fail 2010; 12:254-9. [DOI: 10.1093/eurjhf/hfp202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jeetesh V. Patel
- Haemostasis Thrombosis and Vascular Biology Unit; University of Birmingham Centre for Cardiovascular Sciences, City Hospital; Birmingham UK
| | - Abraheem Abraheem
- North Staffordshire Cardiac Centre; University Hospital of North Staffordshire; Stoke-on-Trent UK
| | - John Creamer
- North Staffordshire Cardiac Centre; University Hospital of North Staffordshire; Stoke-on-Trent UK
| | - Mark Gunning
- North Staffordshire Cardiac Centre; University Hospital of North Staffordshire; Stoke-on-Trent UK
| | - Elizabeth A. Hughes
- Haemostasis Thrombosis and Vascular Biology Unit; University of Birmingham Centre for Cardiovascular Sciences, City Hospital; Birmingham UK
| | - Gregory Y.H. Lip
- Haemostasis Thrombosis and Vascular Biology Unit; University of Birmingham Centre for Cardiovascular Sciences, City Hospital; Birmingham UK
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Nijjar APK, Wang H, Dasgupta K, Rabi DM, Quan H, Khan NA. Outcomes in a diabetic population of South Asians and whites following hospitalization for acute myocardial infarction: a retrospective cohort study. Cardiovasc Diabetol 2010; 9:4. [PMID: 20096107 PMCID: PMC2816974 DOI: 10.1186/1475-2840-9-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Accepted: 01/22/2010] [Indexed: 11/24/2022] Open
Abstract
Background The aim of this study was to determine whether South Asian patients with diabetes have a worse prognosis following hospitalization for acute myocardial infarction (AMI) compared with their White counterparts. We measured the risk of developing a composite cardiovascular outcome of recurrent AMI, congestive heart failure (CHF) requiring hospitalization, or death, in these two groups. Methods Using hospital administrative data, we performed a retrospective cohort study of 41,615 patients with an incident AMI in British Columbia and the Calgary Health Region between April 1, 1995, and March 31, 2002. South Asian ethnicity was determined using validated surname analysis. Baseline demographic characteristics and co-morbidities were included in Cox proportional hazard models to compare time to reaching the composite outcome and its individual components. Results Among the AMI cohort, 29.7% of South Asian patients and 17.6% of White patients were identified as having diabetes (n = 7416). There was no significant difference in risk of developing the composite cardiovascular outcome (Hazard Ratio = 0.90, 95% CI = 0.80-1.01). However, South Asian patients had significantly lower mortality at long term follow-up (HR = 0.62, 95% CI = 0.51-0.74) compared to their White counterparts. Conclusions Following hospitalization for AMI, South Asian patients with diabetes do not have a significantly different long term risk of a composite cardiovascular outcome compared to White patients with diabetes. While previous research has suggested worse cardiovascular outcomes in the South Asian population, we found lower long-term mortality among South Asians with diabetes following AMI.
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Affiliation(s)
- Aman P K Nijjar
- Department of Medicine, University of British Columbia, BC, Canada.
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Patel JV, Tracey I, Hughes EA, Lip GYH. Omega-3 polyunsaturated fatty acids: a necessity for a comprehensive secondary prevention strategy. Vasc Health Risk Manag 2009; 5:801-10. [PMID: 19812692 PMCID: PMC2754093 DOI: 10.2147/vhrm.s4307] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Indexed: 01/15/2023] Open
Abstract
Long-chain omega-3 polyunsaturated fatty acid (PUFA) supplementation has been used for the secondary prevention of fatal and nonfatal myocardial infarction (MI). However, the benefit of this therapy is frequently confused with other established treatments in the therapeutic strategy among such patients. We review the data on omega-3 PUFA use in secondary care and consider indications for its use which include post-MI and raised triglycerides. We suggest that the available evidence supports the use of omega-3 supplementation as part of the comprehensive secondary care package for post-MI patients.
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Affiliation(s)
- Jeetesh V Patel
- Haemostasis, Thrombosis and Vascular Biology Unit, University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, England, UK.
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Eapen D, Kalra GL, Merchant N, Arora A, Khan BV. Metabolic syndrome and cardiovascular disease in South Asians. Vasc Health Risk Manag 2009; 5:731-43. [PMID: 19756165 PMCID: PMC2742703 DOI: 10.2147/vhrm.s5172] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
This review discusses the prevalence of metabolic syndrome and cardiovascular disease in the South Asian population, evaluates conventional and emerging risk factors, and reinforces the need for ethnic-specific redefinition of guidelines used to diagnose metabolic syndrome. We reviewed recent and past literature using Ovid Medline and PubMed databases. South Asians represent one of the largest and fastest growing ethnic groups in the world. With this growth, a dramatic rise in the rates of acute myocardial infarction and diabetes is being seen in this population. Potential etiologies for this phenomenon include dietary westernization, poor lifestyle measures, adverse body fat patterning, and genetics. While traditional risk factors for diabetes and cardiovascular disease should not be overlooked, early metabolic syndrome has now been shown in the South Asian pediatric population, suggesting that "metabolic programming" and perinatal influences may likely play a substantial role. Health care practitioners must be aware that current guidelines used to identify individuals with metabolic syndrome are underestimating South Asian individuals at risk. New ethnic-specific guidelines and prevention strategies are discussed in this review and should be applied by clinicians to their South Asian patients.
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Affiliation(s)
- Danny Eapen
- Emory University School of Medicine, Atlanta, GA, USA.
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Abstract
Background and Purpose—
Within the United Kingdom, mortality from stroke is higher among South Asians compared to European whites. The reasons for this excess cerebrovascular risk in South Asians remain unclear. The aim of this review is to present a comprehensive and systematic overview of the available literature relating to ischemic stroke among South Asian populations identifying distinct features of stroke epidemiology in this group.
Summary of Review—
A high frequency of lacunar strokes is a familiar pattern among South Asians, which suggests a greater prevalence of small-vessel disease in South Asians. This may be a consequence of abnormal metabolic and glycemic processes. In addition, stroke mortality among South Asians appears to be explained by glycemic status, which is an independent predictor of long-term stroke mortality. Within India, there is a perceptible rural–urban gradient in stroke prevalence, underlying the dangers of the rapid transition in socioeconomic circumstances seen across the Indian subcontinent.
Conclusions—
This review emphasizes the importance of further research into ischemic stroke for South Asians given their higher cardiovascular disease burden and necessity for targeted healthcare approaches.
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Affiliation(s)
- Ashan Gunarathne
- From the University Department of Medicine (A.G., J.V.P., B.G., E.A.H., G.Y.H.L.), City Hospital, Birmingham, UK.; and the Department of Primary Care and General Practice (P.S.G.), University of Birmingham, Birmingham, UK
| | - Jeetesh V. Patel
- From the University Department of Medicine (A.G., J.V.P., B.G., E.A.H., G.Y.H.L.), City Hospital, Birmingham, UK.; and the Department of Primary Care and General Practice (P.S.G.), University of Birmingham, Birmingham, UK
| | - Brian Gammon
- From the University Department of Medicine (A.G., J.V.P., B.G., E.A.H., G.Y.H.L.), City Hospital, Birmingham, UK.; and the Department of Primary Care and General Practice (P.S.G.), University of Birmingham, Birmingham, UK
| | - Paramjit S. Gill
- From the University Department of Medicine (A.G., J.V.P., B.G., E.A.H., G.Y.H.L.), City Hospital, Birmingham, UK.; and the Department of Primary Care and General Practice (P.S.G.), University of Birmingham, Birmingham, UK
| | - Elizabeth A. Hughes
- From the University Department of Medicine (A.G., J.V.P., B.G., E.A.H., G.Y.H.L.), City Hospital, Birmingham, UK.; and the Department of Primary Care and General Practice (P.S.G.), University of Birmingham, Birmingham, UK
| | - Gregory Y.H. Lip
- From the University Department of Medicine (A.G., J.V.P., B.G., E.A.H., G.Y.H.L.), City Hospital, Birmingham, UK.; and the Department of Primary Care and General Practice (P.S.G.), University of Birmingham, Birmingham, UK
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Patel JV, Lim HS, Dubb K, Hughes EA, Lip GYH. Circulating levels of adiponectin, leptin, and tumour necrosis factor alpha in hypertension. Ann Med 2009; 41:291-300. [PMID: 19172446 DOI: 10.1080/07853890802672839] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Abnormal adipocyte function is implicated in the coalition of multiple cardiovascular risk factors, where aberrant circulating levels of the adipose-derived hormones adiponectin, leptin, and tumour necrosis factor (TNF) alpha may provide the putative link between hypertension and increased cardiovascular risk. The pragmatic utility of these 'adipocytokines' in the clinical setting of hypertension is unclear, and we hypothesized a relationship of circulating adipocytokines to hypertension, and associated cardiovascular morbidity. METHOD Using a cross-sectional approach, we measured plasma adipocytokines in 278 'high-risk' treated hypertensive participants of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) study (mean (SD) age 62.9 (7.7) years), who were compared to 54 newly diagnosed untreated hypertensives (61.3 (10.9) years) and 55 healthy controls (48.3 (12.3) years). RESULTS Levels of all three adipocytokines were lower amongst treated hypertensives compared to newly diagnosed hypertensives and healthy controls (P<0.001 for leptin and adiponectin), and varied with gender, co-morbidities (e.g. diabetes, cardiovascular disease (CVD), left ventricular hypertrophy) and by treatments (e.g. statins and beta-blockade). Levels of adiponectin (P<0.001) and leptin (P=0.02) rose in an ordinal fashion with increasing hypertension severity (grade). Levels of leptin were associated with diastolic blood pressure in a positive fashion (P<0.001). CONCLUSIONS While hypertension affects adipocytokine levels, the clinical interpretation of circulating levels in hypertension is confounded by a range of factors. The positive relation between leptin and adiponectin with hypertension severity may reflect an underlying adaptive response that is attenuated during pharmacological hypertension management.
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Affiliation(s)
- Jeetesh V Patel
- Haemostasis, Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, England, UK
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Impact of mean arterial blood pressure on higher arterial stiffness indices in South Asians compared to white Europeans. J Hypertens 2008; 26:1420-6. [DOI: 10.1097/hjh.0b013e3282ffb42a] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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