Cardiovascular diseases in Chinese, Malays, and Indians in Singapore. I. Differences in mortality.

Hughes, Kenneth; Lun, K. C.; Yeo, P. P. B.

doi:10.1136/jech.44.1.24

Cited by 124 publications

(63 citation statements)

References 12 publications

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“…This finding is in accordance with previous findings [11,[15][16][17][18][19][20][21]. As in previous studies, adjustment for other traditional risk factors did not entirely account for the increased risk of IHD in this ethnic group [11,19].…”

Section: Discussionsupporting

confidence: 83%

Ethnicity modifies the association between diabetes mellitus and ischaemic heart disease in Chinese, Malays and Asian Indians living in Singapore

et al. 2006

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Aims/hypothesis The aim of the study was to determine whether the risk of ischaemic heart disease (IHD) associated with diabetes mellitus differs between ethnic groups. Methods Registry linkage was used to identify IHD events in 5707 Chinese, Malay and Asian Indian participants from three cross-sectional studies conducted in Singapore between the years 1984 and 1995. The study provided a median of 10.2 years of follow-up with 240 IHD events experienced. We assessed the interaction between diabetes mellitus and ethnicity in relation to the risk of IHD events using Cox proportional hazards regression. Results Diabetes mellitus was more common in Asian Indians. Furthermore, diabetes mellitus was associated with a greater risk of IHD in Asian Indians. The hazard ratio when comparing diabetes mellitus with non-diabetes mellitus was 6.41 (95% CI 5.77-7.12) in Asian Indians and 3.07 (95% CI 1.86-5.06) in Chinese (p=0.009 for interaction). Differences in the levels of established IHD risk factors among diabetics from the three ethnic groups did not appear to explain the differences in IHD risk. Conclusions/interpretation Asian Indians are more susceptible to the development of diabetes mellitus than Chinese and Malays. When Asian Indians do develop diabetes mellitus, the risk of IHD is higher than for Chinese and Malays. Consequently, the prevention of diabetes mellitus amongst this ethnic group is particularly important for the prevention of IHD in Asia, especially given the size of the population at risk. Elucidation of the reasons for these ethnic differences may help us understand the pathogenesis of IHD in those with diabetes mellitus.

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Section: Discussionsupporting

confidence: 83%

Ethnicity modifies the association between diabetes mellitus and ischaemic heart disease in Chinese, Malays and Asian Indians living in Singapore

et al. 2006

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“…Furthermore, we have shown that increasing PBF in men and women, especially to levels beyond the overweight and obese cutoff points, was associated with higher levels of TC, LDL, TC/HDL, INS, and GLU and lower levels of HDL. Clearly, the classifications based on DEXAderived PBF in the present study showed that obesity was associated with increased risks of coronary heart disease and type 2 diabetes, as was shown earlier (13,15,26,29).…”

Section: Discussionsupporting

confidence: 52%

Are BMI and other anthropometric measures appropriate as indices for obesity? A study in an Asian population

Goh

Tain

Tong

et al. 2004

Journal of Lipid Research

101

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We have examined the relationships between percentage of body fat (PBF) and risk factors for cardiovascular disease and insulin resistance and how good body mass index (BMI) and other anthropometric measures are as indices of obesity. High PBF levels were associated with increased risk of cardiovascular disease and insulin resistance. The World Health Organization BMI of 30 kg/m 2 for obesity has low sensitivity, 6.7% and 13.4% for men and women, respectively. For every obese man and woman identified, 6.7 and 1.76 times nonobese men and women, respectively, will be misclassified as obese. With the locally established BMI cutoff point for obesity of 27 kg/m 2 for men and 25 kg/m 2 for women, the sensitivity was improved to 46.7% and 60.8%, respectively. For every obese man and woman identified, 3.76 and 1.64 times nonobese men and women, respectively, will be misclassified as obese. None of the other anthropometric indices was better than the locally established BMIs. We showed that the BMIs for obesity for our local men and women are different. These BMIs were most precise among all indices studied. However, they still lead to high false-positive rates. For more effective management of the problem of obesity, we need to develop more precise, simple, and cost-effective methods for the measurement of PBF. With increasing affluence and a rapidly aging population, lifestyle diseases such as cancers and coronary heart disease have become the major causes of death in Singapore (1). Coronary heart disease is the second leading cause of death, accounting for 24.5% of all deaths in 2000 (2). This mortality rate is comparable to those observed in the West and higher than those in other parts of Asia, such as Japan and Hong Kong (3). A key issue in the management of coronary heart disease is prevention. Many of the predisposing risk factors, including obesity, can be prevented or modified through appropriate lifestyle changes and medical treatment.The body mass index (BMI) has been used routinely to classify subjects as obese or nonobese. The World Health Organization (WHO) and the International Obesity Task Force recommend the BMI cutoff point of 30 kg/m 2 for obesity. This cutoff point was derived largely from mortality statistics from European and American populations. Several studies carried out mainly among Asian populations have challenged the notion that one BMI cutoff point fits all populations. They have separately established that the BMI cutoff point for obesity for Asian populations is pegged between 23 and 27 kg/m 2 (4-9). Furthermore, studies have shown that Asian populations have high risks of type 2 diabetes, cardiovascular disease, and mortality from other causes at relatively lower BMI, which they postulated to be largely attributable to the higher proportion of body fat in Asian populations (10-16). Therefore, it has been suggested that lower BMI cutoff points for obesity appropriate for Asian populations should be adopted. In its Lancet publication in 2004, the WHO Expert Consultation, after a ...

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“…More than 50% of CAD associated death in India occurs before the patient reaches the age of 50 years (28) and 25% of myocardial infarction (MI) occur before the age of 40 years (29). Heart disease is occurring in Asian Indians 5-10 years before other ethnicities (30) because the CAD shows accelerated atherogenesis which results in higher premature morbidity and mortality (31). Since Asian Indians have a lower prevalence of conventional risk factors such as hypertension, hypercholesterolemia, obesity and smoking (8,13,32) it is important to explore the underlying causes of increased CAD prevalence.…”

Section: Risk Factorsmentioning

confidence: 99%

Asian-Indians: a review of coronary artery disease in this understudied cohort in the United States

Ardeshna¹,

Bob‐Manuel²,

Nanda³

et al. 2018

Ann. Transl. Med.

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Coronary artery disease (CAD) is a major cause of cardiovascular death worldwide. Prevalence of CAD is highly variable among different races. Asian Indians have been noted to have the highest CAD rates and the conventional risk factors fail to explain this difference completely. Asian Indians constitute a fifth of the global population, and the higher rates of CAD in this population constitute a major health challenge.There have been studies in the early 2000s that investigate the risk factors in this population; however, very few studies have been done since then that explore the higher CAD rates in Asian Indians. This is a comprehensive and current review of the known risk factors for CAD in Asian Indians and strategies physicians should consider relieving this burden.

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Cardiovascular diseases in Chinese, Malays, and Indians in Singapore. I. Differences in mortality.

Abstract: Study objective-The aim ofthe

Cited by 124 publications

References 12 publications

Ethnicity modifies the association between diabetes mellitus and ischaemic heart disease in Chinese, Malays and Asian Indians living in Singapore

Ethnicity modifies the association between diabetes mellitus and ischaemic heart disease in Chinese, Malays and Asian Indians living in Singapore

Are BMI and other anthropometric measures appropriate as indices for obesity? A study in an Asian population

Asian-Indians: a review of coronary artery disease in this understudied cohort in the United States

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