Cardiovascular and Mortality Risks in Migrant South Asians with Type 2 Diabetes: Are We Winning the Battle?

Abstract

Purpose of ReviewWe seek to describe the relationship between diabetes mellitus and cardiovascular risk in migrant South Asians compared to native white Europeans, and to determine the temporal change in this relationship over recent years.Recent FindingsRecent evidence suggests that the excess mortality risk associated with diabetes is lower in the migrant South Asian population compared with white Europeans. By contrast, South Asians continue to demonstrate elevated cardiovascular morbidity compared to white Europeans, although to a lesser extent than was observed in previous decades.SummaryThe excess mortality previously observed in South Asian migrants has attenuated with a lower mortality risk compared to white Europeans observed in several recent studies. We speculate that these findings may relate in part to earlier diabetes diagnosis and more prolonged exposure to cardiovascular risk factor management in the South Asian population. Further study is required to confirm these hypotheses.

Contribution of type 2 diabetes to all-cause mortality, cardiovascular disease incidence and cancer incidence in white Europeans and South Asians: findings from the UK Biobank population-based cohort study

“…In accordance with previous studies, this study reported differences in CVD and cancer risk between white European and South Asian participants 11 25 26. In the future, it might be important to consider that when the high CVD risk among South Asians is better managed in these populations, this may impact on cancer risk.…”

“…Although results from the study of Tillin et al 11 were published recently, follow-up started between 1988 and 1991. It was speculated therefore that over time mortality risk may have changed due to an improvement in CVD management 26. In addition, in past decades greater attention has been paid to the differences in disease risk between ethnicities within healthcare, for example, in diabetes screening.…”

Type 2 diabetes in South Asians compared to Europeans: Higher risk and earlier development of major cardiovascular events irrespective of the presence and degree of retinopathy. Results from The HinDu The Hague Diabetes Study

“…[18][19][20] A hopeful development is that the difference in CV morbidity and mortality between South Asians and Europeans declined after 2000, following the introduction of statins as a standard primary prevention therapy for patients with type 2 diabetes. 21 practice-based), most of our data were either in line or comparable with international data. In addition, our use of double-staged data collection reduced the risk of missing data.…”

“…Finally, given the nature of our data set, we did not analyse the temporal changes suggested by some, even though temporal shifts, that is a lower CV risk profile in the younger generation, may well exist. 21…”

Age-, sex- and ethnicity-related differences in body weight, blood pressure, HbA1c and lipid levels at the diagnosis of type 2 diabetes relative to people without diabetes

“…This may arise from the higher diabetes incidence rates seen in younger age groups or may reflect the age distribution of the different ethnic groups. South Asian and black people were observed to present with a different cardiometabolic risk profile, with typically higher HbA 1c , lower BMI, and established micro- and macrovascular complications [ 14 , 31 – 33 ]. As identified previously by Paul et al [ 14 ], and shown in this cohort, white people with type 2 diabetes had a pattern of presenting with higher BMI at any age compared with South Asian and black people, with larger ethnic differences in BMI levels reported at younger ages.…”