Mortality and morbidity from diabetes in South Asians and Europeans: 11-year follow-up of the Southall Diabetes Survey, London, UK

Mather, H.; Chaturvedi, Nishi; Fuller, JH

doi:10.1002/(sici)1096-9136(199801)15:1<53::aid-dia521>3.0.co;2-v

Cited by 160 publications

(101 citation statements)

References 2 publications

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“…Possible reasons for this difference could be: (1) the lower age of the UKPDS cohort (25 to 65 years); (2) the setting of a clinical trial rather than a study with 'free-living' participants; (3) the fact that UKPDS subjects were newly diagnosed with diabetes; and (4) the inclusion of both fatal and non-fatal events in UKPDS. However, our findings are in accord with our previous reports based on death certificate data, where we found a twofold to fourfold higher CHD mortality rate in South Asian than in European diabetic patients [18,19]. Our current findings are novel, as we report for the first One key question, given the greater prevalence of diabetes, and its marked association with CHD death in South Asians in our study, is: why did the presence of diabetes fail to account for the higher CHD mortality experience of South Asians?…”

Section: Discussionsupporting

confidence: 93%

“…Conceivably, much of the ethnic difference between those with and without diabetes is attributable to the different duration of diabetes in the two groups, and this should be the subject of future study. In an earlier study of diabetic individuals aged 30 to 64 years, we reported a doubling of CHD mortality risk in 730 diabetic South Asians compared with 304 diabetic Europeans in analyses adjusted for age, sex and diabetes duration [19]. However, we cannot rule out the possibility that other unmeasured risk factors, whether associated with insulin resistance or not, could further account for the excess risk of CHD in South Asians.…”

Section: Discussionmentioning

confidence: 67%

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Do known risk factors explain the higher coronary heart disease mortality in South Asian compared with European men? Prospective follow-up of the Southall and Brent studies, UK

et al. 2006

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Aims/hypothesis We examined prospectively whether measured risk factors can explain the higher CHD mortality in South Asians compared with Europeans. Materials and methods Conventional CHD risk factors and those associated with insulin resistance were measured in 1,787 European and 1,420 South Asian men aged 40 to 69 years at baseline in the population-based Southall and Brent studies (London) between 1988 and 1990. Participants were followed up for mortality. Results By February 2006, there were 202 CHD deaths (108 Asian, 94 European). South Asian men had double the CHD mortality of European men in Cox regression analyses adjusted for age, smoking, and cholesterol (hazard ratio [HR] 2.14, 95% CI 1.56-2.94, p<0.001). Nearly half of all South Asian CHD deaths versus 13% of deaths among Europeans were among persons with diabetes. Asian men had greater CHD mortality than Europeans, both in the with-and the without-diabetes categories at baseline. CHD mortality remained significantly higher in South Asian men in multivariable models that adjusted for conventional risk factors and diabetes and/or impaired glucose regulation, features of insulin resistance, or the metabolic syndrome (HR 1.6-1.9). Accounting for comorbidity and socio-economic status did not materially alter the findings. Conclusions/interpretation These data confirm that South Asian men have significantly higher CHD mortality than their European counterparts, while indicating that neither conventional risk factors, nor insulin resistance parameters or metabolic syndrome criteria as currently defined can account for this excess risk. The contribution of unmeasured factors to the elevated vascular risk in South Asians should be addressed in future studies.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 67%

Do known risk factors explain the higher coronary heart disease mortality in South Asian compared with European men? Prospective follow-up of the Southall and Brent studies, UK

et al. 2006

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“…In the USA it has been reported that Asians (comprising primarily Chinese and Filipinos) with diabetes mellitus have a lower risk of IHD compared with their white counterparts [2,7]. In the UK, Asian Indians with diabetes mellitus have been reported to have a higher rate of IHD [8] than whites with diabetes mellitus in one study and similar rates in another [9].…”

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confidence: 92%

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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“…3 These differences are not entirely explained by the presence or absence of traditional cardiovascular risk factors 4,5 and therefore the investigation of other factors that are markers of excess cardiovascular risk is required to establish appropriate thresholds for intervention and treatment targets in this ethnic group.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of microalbuminuria and hypertension in South Asians and white Europeans with type 2 diabetes: a report from the United Kingdom Asian Diabetes Study (UKADS)

Dixon

Raymond

Mughal

et al. 2006

Diabetes and Vascular Disease Research

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Microalbuminuria is more common in South Asian individuals compared to white Europeans. The aim of this study was to determine the relationship between blood pressure and microalbuminuria in a cohort of patients with type 2 diabetes in these two ethnic groups. These further data were analysed from 552 patients (311 South Asian patients and 241 white Europeans) who had microalbuminuria screening data collected. Prevalence of microalbuminuria was significantly higher in South Asian compared with white European patients (31% versus 20%, p=0.007). Among patients with normal, untreated blood pressure, the proportion who had microalbuminuria was three times higher among South Asian patients compared with the white European group (30.7% versus 10.1%, p=0.049, relative risk = 3.1 [1.0-9.5]). In addition, despite their higher cardiovascular risk, South Asian patients were less likely to be prescribed a statin or antihypertensive drug treatment.In conclusion, thresholds and targets for treatment of cardiovascular risk factors in South Asians may need to be lower than those for white Europeans, and targeted intervention will be required to achieve this. 2006;3:22-5 Diabetes Vasc Dis Res

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Mortality and morbidity from diabetes in South Asians and Europeans: 11-year follow-up of the Southall Diabetes Survey, London, UK

Cited by 160 publications

References 2 publications

Do known risk factors explain the higher coronary heart disease mortality in South Asian compared with European men? Prospective follow-up of the Southall and Brent studies, UK

Do known risk factors explain the higher coronary heart disease mortality in South Asian compared with European men? Prospective follow-up of the Southall and Brent studies, UK

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

Prevalence of microalbuminuria and hypertension in South Asians and white Europeans with type 2 diabetes: a report from the United Kingdom Asian Diabetes Study (UKADS)

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