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

Abstract

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.

Heart Disease in Asia

“…The ethnic differences in the association between diabetes mellitus and ischemic heart disease are noted even within Asian populations. 3 In Asian countries, as a consequence of the economic developments, the prevalence of overweight and obesity is increasing, and more important, rates of diabetes are increasing even more quickly. In particular, a moderate increase in body mass index makes South Asians more prone to insulin resistance and related diseases.…”

Ischemic heart disease: effectiveness and safety of statin treatment in a malaysian tertiary healthcare facility

“…This is especially true in view of the effectiveness in reducing lipid levels in this group of patients [9]. There have been numerous studies demonstrating the lipid lowering effects of statin in various patient populations [2,4]. However, its effects have been notably varied with interindividual differences [2].…”

“…It is also the leading cause of death in Malaysia, accounting for 2,556 deaths in 2002 [2]. Several risk factors have been identified that increases the likelihood of IHD.…”

Trends in the Incidence and Mortality of Coronary Heart Disease in Asian Pacific Region

“…In a 10-year prospective observational study that involved 5,707 participants of Chinese, Malay and Asian Indian participants from 3 cross-sectional studies conducted in Singapore, Yeo KK et al showed that ethnicity modified the risk of CHD associated with diabetes mellitus 33) . They showed that over and above the increased baseline risk of CHD, diabetes mellitus had a larger effect on the risk of CHD in Asian Indians than in Chinese and Malays 33) . The population attributable risk of CHD related to diabetes mellitus was 40.9% in Asian Indians compared with 27.9% in Malays and 11.0% in Chinese.…”