Diabetes and Cardiac Disease
Diabetes and Cardiac Disease
South Asians have a higher prevalence of diabetes, coronary heart disease and cardiovascular death. Their predisposition to insulin resistance partly explains this excess risk. After immigration, the adoption of a western diet allied to increased sedentary behaviour leads to weight gain, hypertension and hyperlipidaemia, factors which in turn combine to amplify the chances of getting heart disease. Further contributory factors are increased sub-clinical inflammation, increased thrombogenic tendency and higher serum homocysteine levels. South Asians with diabetes might do as well as White people with respect to intensive glycaemic and blood pressure control. However, there is little evidence for measures to reduce cardiovascular risk as South Asians have not been included as a subgroup in most large trials. Future prospective studies, including studies on the prevention of diabetes and cardiovascular disease in this high-risk population, are therefore urgently required.
The prevalence of type 2 diabetes is three- to six-fold higher among immigrant South Asians (persons of Pakistani, Indian or Bangladeshi origin) than whites. This is similar to the high prevalence of diabetes in certain urban and rural parts of India. One-fifth of the world's population lives in South Asia, and the projected prevalence of type 2 diabetes is set to double in this area over the next 20 years. The incidence of CHD and cardiovascular death is also very high in South Asians with and without diabetes, and there is also early evidence of rising CHD alongside diabetes in India. In this review we examine the burden of cardiovascular disease in South Asians, the roles of diabetes, insulin resistance and related risk factor pathways, and of possible interventions to reduce cardiovascular risk.
South Asians have a higher prevalence of diabetes, coronary heart disease and cardiovascular death. Their predisposition to insulin resistance partly explains this excess risk. After immigration, the adoption of a western diet allied to increased sedentary behaviour leads to weight gain, hypertension and hyperlipidaemia, factors which in turn combine to amplify the chances of getting heart disease. Further contributory factors are increased sub-clinical inflammation, increased thrombogenic tendency and higher serum homocysteine levels. South Asians with diabetes might do as well as White people with respect to intensive glycaemic and blood pressure control. However, there is little evidence for measures to reduce cardiovascular risk as South Asians have not been included as a subgroup in most large trials. Future prospective studies, including studies on the prevention of diabetes and cardiovascular disease in this high-risk population, are therefore urgently required.
The prevalence of type 2 diabetes is three- to six-fold higher among immigrant South Asians (persons of Pakistani, Indian or Bangladeshi origin) than whites. This is similar to the high prevalence of diabetes in certain urban and rural parts of India. One-fifth of the world's population lives in South Asia, and the projected prevalence of type 2 diabetes is set to double in this area over the next 20 years. The incidence of CHD and cardiovascular death is also very high in South Asians with and without diabetes, and there is also early evidence of rising CHD alongside diabetes in India. In this review we examine the burden of cardiovascular disease in South Asians, the roles of diabetes, insulin resistance and related risk factor pathways, and of possible interventions to reduce cardiovascular risk.
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