The pattern and severity of coronary artery disease in Asians and whites living in Birmingham

Lowry, P J; Mace, P. J. E.; Glover, D. R.; Littler, W. A.

doi:10.1136/pgmj.59.696.634

Cited by 8 publications

(7 citation statements)

References 3 publications

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“…There is evidence for this. Our mortality patterns in South Asians are similar to those reported by Mak et al in Singapore [33] and compatible with the in-hospital mortality figures in studies by Mukhtar et al [34], Lowry et al [35], Lear et al [36], and Gupta et al [38]. Macintyre et al [43] have shown an association between social and economic deprivation and survival in Scotland, which might account for Scotland's relatively high mortality.…”

Section: Discussionsupporting

confidence: 92%

“…Muhktar found no significant difference in survival up to 4 years after discharge in 111 South Asians and matched non-South Asian controls [34]. Studies agreeing with this conclusion include those by Lowry et al in Birmingham [35], Hughes et al in London [27], Lear et al in Leicester [36], Liew et al in London [37], Gupta et al in Toronto, Canada [38], and Mak et al in Singapore [33]. Wilkinson et al's work is unusual in showing a substantially poorer survival in South Asians [26].…”

Section: Discussionmentioning

confidence: 94%

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Record linked retrospective cohort study of 4.6 million people exploring ethnic variations in disease: myocardial infarction in South Asians

Fischbacher

Povey

et al. 2007

BMC Public Health

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BackgroundLaw and policy in several countries require health services to demonstrate that they are promoting racial/ethnic equality. However, suitable and accurate data are usually not available. We demonstrated, using acute myocardial infarction, that linkage techniques can be ethical and potentially useful for this purpose.MethodsThe linkage was based on probability matching. Encryption of a unique national health identifier (the Community Health Index (CHI)) ensured that information about health status and census-based ethnicity could not be ascribed to an identified individual. We linked information on individual ethnic group from the 2001 Census to Scottish hospital discharge and mortality data.ResultsOverall, 94% of the 4.9 million census records were matched to a CHI record with an estimated false positive rate of less than 0.1 %, with 84.9 – 87.6% of South Asians being successfully linked. Between April 2001 and December 2003 there were 126 first episodes of acute myocardial infarction (AMI) among South Asians and 30,978 among non-South Asians. The incidence rate ratio was 1.45 (95% CI 1.17, 1.78) for South Asian compared to non-South Asian men and 1.80 (95% CI 1.31, 2.48) for South Asian women. After adjustment for age, sex and any previous admission for diabetes the hazard ratio for death following AMI was 0.59 (95% CI 0.43, 0.81), reflecting better survival among South Asians.ConclusionThe technique met ethical, professional and legal concerns about the linkage of census and health data and is transferable internationally wherever the census (or population register) contains ethnic group or race data. The outcome is a retrospective cohort study. Our results point to increased incidence rather than increased case fatality in explaining high CHD mortality rate. The findings open up new methods for researchers and health planners.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 94%

Record linked retrospective cohort study of 4.6 million people exploring ethnic variations in disease: myocardial infarction in South Asians

Fischbacher

Povey

et al. 2007

BMC Public Health

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“…Coronary angiography after first myocardial infarction (MI) in British Asians and Caucasians showed a higher incidence of triple vessel disease in the former.2 Significantly more severe disease has also been reported in British Asians than Caucasians. 3 The distribution of disease, that is, proximal versus distal, however, has been found to be similar. 3 There are no reports of angiographic comparisons of CAD between Asians from the UK, from the Indian sub-continent, and Caucasians.…”

Section: Introductionmentioning

confidence: 98%

“…3 The distribution of disease, that is, proximal versus distal, however, has been found to be similar. 3 There are no reports of angiographic comparisons of CAD between Asians from the UK, from the Indian sub-continent, and Caucasians.…”

Section: Introductionmentioning

confidence: 98%

Angiographic comparison of coronary artery disease between Asians and Caucasians

Dhawan

Bray

1994

Postgraduate Medical Journal

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Summary:Asians in the United Kingdom surpass the already high mortality from coronary artery disease seen in Caucasians. In the present study, the angiographic features of consecutive series of 87 Caucasians, 83 British Asian and 30 Asian patients in India with coronary artery disease were assessed. Blood samples at fasting and after ingestion of75 g ofdextrose were taken to assess the extent ofdiabetes. Fasting blood samples were also taken for measurement of cholesterol, high-density lipoprotein cholesterol and triglyceride. Coronary angiograms were scored by two independent observers who were blinded to the patients' ethnic origin.The Asians were younger than the Caucasians, but did not differ in their body mass index, systolic or diastolic blood pressure or in cigarette consumption. Lipids were similar apart from Indian Asians having lower cholesterol than British Asians, and Caucasians having lower triglyceride than Asians. There were more diabetics in Asians than in Caucasians. Asians in Britain wait longer than Caucasians and Asians in India from onset of angina to undergoing coronary angiography.The presence oftriple vessel disease was not significantly different (P = 0.19) in the three groups, that is, 38%, 43% and 27% in Caucasians, British Asians and Indian Asians, respectively. The geometric mean coronary score was 26.3 (C.I. 22.6-30.6), 25.3 (C.I. 21.8-29.4), and 25.2 (C.I. 19.6-32.5) in Caucasians, British Asians and Indian Asians, respectively. This difference was not significant (P = 0.92). Total number of lesions more than three were similar, that is, in 25% Caucasian, 41% British Asian and 40% Indian Asian patients (P <0.10). British Asians had less proximal disease (P = 0.0002), and Indian Asians less distal disease (P = 0.003) compared to Caucasians. Non-discrete (long) lesions were more prevalent in Asians than Caucasians (P = 0.0005).The total number of lesions more than three in diabetic Asians was significantly more than in the non-diabetic, 71% versus 31% in British Asians (P = 0.002) and 90% versus 15% in Indian Asians (P= 0.0001). The relationship between diabetes and long lesions in both British and Indian Asians was highly significant (P < 0.00001 and P < 0.001, respectively).Thus severity and extent of coronary disease is no different in Asians as compared to Caucasians. Diabetes is perhaps responsible for the more diffuse disease seen in Asians.

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“…3 Mortality from coronary artery disease (CAD) is 40% higher amongst Indo-Asians, when compared to the indigenous Caucasian population. Indo-Asians also have four times the risk of developing myocardial infarction (MI), with more extensive CAD seen angiographically 4. Indeed, the mortality from CAD amongst Indo-Asians has been generally increasing, whilst the overall mortality has generally been decreasing in European countries.…”

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confidence: 99%

Do Indo-Asians have smaller coronary arteries?

Lip

Rathore

Katira

et al. 1999

Postgraduate Medical Journal

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SummaryThere is a widespread belief that coronary arteries are smaller in Indo-Asians. The aim of the present study was to compare the size of atheroma-free proximal and distal epicardial coronary arteries of Indo-Asians and Caucasians. We analysed normal coronary angiograms from 77 Caucasians and 39 Indo-Asians. The two groups were comparable for dominance of the coronary arteries. Indo-Asian patients had generally smaller coronary arteries, with a statistically significant diVerence in the mean diameters of the left main coronary artery, proximal, mid and left anterior descending, and proximal and distal right coronary artery segments. There was a non-significant trend towards smaller coronary artery segment diameters for the distal left anterior descending, proximal and distal circumflex, and obtuse marginal artery segments. However, after correction for body surface area, none of these diVerences in size were statistically significant. Thus, the smaller coronary arteries in Indo-Asian patients were explained by body size alone and were not due to ethnic origin per se. This finding nevertheless has important therapeutic implications, since smaller coronary arteries may give rise to technical diYculties during bypass graft and intervention procedures such as percutaneous transluminal coronary angioplasty, stents and atherectomy. On smaller arteries, atheroma may also give an impression of more severe disease than on larger diameter arteries.

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The pattern and severity of coronary artery disease in Asians and whites living in Birmingham

Cited by 8 publications

References 3 publications

Record linked retrospective cohort study of 4.6 million people exploring ethnic variations in disease: myocardial infarction in South Asians

Record linked retrospective cohort study of 4.6 million people exploring ethnic variations in disease: myocardial infarction in South Asians

Angiographic comparison of coronary artery disease between Asians and Caucasians

Do Indo-Asians have smaller coronary arteries?

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