Diabetes, hyperinsulinaemia, and coronary risk factors in Bangladeshis in east London.

Abstract

Immigrants from the Indian subcontinent (South Asians) in England and Wales have higher morbidity and mortality from coronary heart disease than the general population; this seems to apply to both Hindus and Muslims. Studies in north west London and Trinidad found that the increased risk of coronary heart disease in Indians was not explained by dietary fat intakes, smoking, blood pressure, or plasma lipids. In the present study the distribution of coronary risk factors was measured in an East London borough where the mortality and attack rate from coronary heart disease are higher in the Asian population, predominantly Muslims from Bangladesh, than in the rest of the population. In a sample of 253 men and women aged 35-69 from general practice, mean plasma cholesterol concentrations were lower in Bangladeshi than in European men and women. Mean systolic blood pressures were 10 mm Hg lower in Bangladeshis. Plasma fibrinogen concentrations were similar in Bangladeshis and Europeans and factor VII coagulant activity was lower in Bangladeshi than in European men. In contrast with the findings in Hindus in north west London, smoking rates were high in Bangladeshi men and the ratio of polyunsaturated fatty acids to saturated fatty acids in plasma lipids was lower in Bangladeshis than in Europeans. Diabetes was three times more common in Bangladeshis than in Europeans and serum insulin concentrations measured after a glucose load were twice as high in Bangladeshis. High insulin concentrations in Bangladeshis were associated with high plasma triglyceride and low high-density lipoprotein cholesterol concentrations. Insulin resistance, leading to diabetes, hyperinsulinaemia, and secondary lipoprotein disturbances, is a possible mechanism for the high rates of coronary heart disease in South Asians in Britain and overseas.

Sex difference in blood pressure among South Asian diaspora in Europe and North America and the role of BMI: a meta-analysis

“…Participants were sampled from general practitioner registers or health centres and community hospital registries. 12,[14][15][16][17][18] Two studies used samples from a population or community register. 20,21 One study used samples from areas as identified by the postcode directory.…”

“…17,18 Three studies reported on multiple South Asian subgroups (Indian, Pakistani, Bangladeshi) separately, 18,22,23 others reported only one subgroup or a combined South Asian population. [14][15][16][17]19,20,26 Most studies used Hawksley random zero sphygmomanometers to measure BP, 15,16,19 whereas two studies used mercury, 18,21 or automated devices such as the Omron (OMRON, Omron Matsusaka Co. Ltd, Kyoto, Japan), Dinamap 8100 (GE Healthcare, Critikon, FL, USA) and Roche (F Hoffmann-La Roche Ltd., Basel, Switzerland) sphygmomanometers. 12,17,20,23 Subjects were seated and quiet for at least 5 min before BP measurement.…”

“…12,17,20,23 Subjects were seated and quiet for at least 5 min before BP measurement. 12,14,15,[17][18][19][20][21] In three studies, 12,17,20 the average of the second and third BP reading was reported and in the other studies, the average of two BP readings (Table 1).…”

“…After contacting three authors to request additional data [11][12][13] and after full text review, the search resulted in 11 eligible articles (Figure 1). [14][15][16][17][18][19][20][21][22] The EMBASE and Google Scholar search did not yield additional articles. A cited reference search resulted in one newly identified article.…”

“…[14][15][16][17][18]20,22,23,26 Figure 4 shows the (18) 113 (14) 78 (9) 75 ( 123 (19) 81 (9) 78 (13) 26. (20) 123 (25) 77 (13) 66 ( (20) 128 (18) 77 (14) 75 (12) WMD for BMI within the European origin populations.…”