CADI Diaspora Overview
- In general, CVD (cardiovascular disease) rates among immigrants are intermediate between that of the country of origin and the country of immigration. The rates blend with that of the adopted country in two to three generations.1
- Asian Indians have been a singular exception to this rule among whom the rates continue to diverge compared to compatriots of other ethnic origin in successive generations.1
- Studies among Indian Diasporas in various parts of the world have documented an increased susceptibility to CAD (coronary artery disease) in comparison to the native population studied.2-6 CAD mortality rates are consistently higher than whites, 3-4 times higher than Chinese and 3-30 times higher than blacks (Figure 025).6
- Asian Indians and other South Asians develop heart disease at a younger age, lower body mass index (BMI) and at a lower waist circumference (WC).7, 8
- The excess burden of CAD among Asian Indians and other South Asian women are as high as or higher than South Asian men, despite low rates of smoking.9
- In the United Kingdom (UK), compared to whites, the death rate from CAD was 36% higher in Indian men and 50% higher in Indian women in 1979. By 2007, the differences in death rate between Indians and whites have further widened and is now 50% higher among Indian men and 90% higher in Indian women.10, 11 The difference is even higher among other South Asians. (see CADI UK)
- CAD rates are decreasing among the Indian Diasporas but at a slower pace than that of the dominant culture. This appears to be due to poor awareness and willingness to control the modifiable risk factors. Arranged marriages as well as endogamy and consanguinity are common among certain segments of the South Asian population and their role deserves greater scientific scrutiny.1, 12, 13
- Metabolic syndrome and diabetes are highly prevalent but do not fully explain the excess burden of CAD.14
- Asian Indian dyslipidemia characterized by high non-HDL cholesterol, high TG (triglycerides), low HDL-C (high-density lipoprotein cholesterol) along with high levels of lipoprotein(a) and high total cholesterol to HDL ratio (TC/HDL) appears to be the principal driver of the excess burden of CAD in Asian Indian men and women.15, 16 17
- See heart disease among Indian Diasporas in selected countries.
1. Jha P, Enas E, Yusuf S. Coronary Artery Disease in Asian Indians: Prevalence and Risk Factors. Asian Am Pac Isl J Health. Autumn 1993;1(2):163-175.
2. Enas EA, Yusuf S, Mehta J. Prevalence of coronary artery disease in Asian Indians. Am J Cardiol. 1992;70:945 – 949.
3. Enas EA, Yusuf S, Mehta J. Meeting of the International Working Group on Coronary Artery Disease in South Asians. 24 March 1996, Orlando, Florida, USA. Indian Heart J. Nov-Dec 1996;48(6):727-732.
4. Balarajan R. Ethnicty and variations in mortality from coronary heart disease. Health Trends. 1996;28:45-51.
5. Harding S, Rosato M, Teyhan A. Trends for coronary heart disease and stroke mortality among migrants in England and Wales, 1979-2003: slow declines notable for some groups. Heart. Apr 2008;94(4):463-470.
6. Enas EA, Senthilkumar A, Chacko V, Puthumana N. Dyslipidemia among Indo-Asians: Strategies for identification and management. Brit J of Diabetes and Vascular Dis. 2005;5:81-90.
7. Enas EA. Coronary artery disease epidemic in Indians: a cause for alarm and call for action. J Indian Med Assoc. Nov 2000;98(11):694-695, 697-702.
8. Enas EA. How to Beat the Heart Disease Epidemic among South Asians: A Prevention and Management Guide for Asian Indians and their Doctors. Downers Grove: Advanced Heart Lipid Clinic USA; 2011.
9. Enas EA, Senthilkumar A, Juturu V, Gupta R. Coronary artery disease in women. Indian Heart J. May-Jun 2001;53(3):282-292.
10. Balarajan R. Ethnic differences in mortality from ischaemic heart disease and cerebrovascular disease in England and Wales. Bmj. Mar 9 1991;302(6776):560-564.
11. www.heartstats.org. CHD Statistics. mortality. 2010. Accessed January 25,2011.
12. Ismail J, Jafar TH, Jafary FH, White F, Faruqui AM, Chaturvedi N. Risk factors for non-fatal myocardial infarction in young South Asian adults. Heart. Mar 2004;90(3):259-263.
13. Kanaya AM, Wassel CL, Mathur D, et al. Prevalence and correlates of diabetes in South asian indians in the United States: findings from the metabolic syndrome and atherosclerosis in South asians living in america study and the multi-ethnic study of atherosclerosis. Metab Syndr Relat Disord. Apr 2010;8(2):157-164.
14. Forouhi NG, Sattar N, Tillin T, McKeigue PM, Chaturvedi N. 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. Diabetologia. Nov 2006;49(11):2580-2588.
15. Enas EA, Chacko V, Senthilkumar A, Puthumana N, Mohan V. Elevated lipoprotein(a)–a genetic risk factor for premature vascular disease in people with and without standard risk factors: a review. Dis Mon. Jan 2006;52(1):5-50.
16. Enas EA, Chacko V, Pazhoor SG, Chennikkara H, Devarapalli HP. Dyslipidemia in South Asian patients. Curr Atheroscler Rep. Nov 2007;9(5):367-374.
17. Enas EA. Why Indians are more susceptible to Coronary artery disease: Role of specific risk factors In: Chatterjee SS, ed. Update in Cardiology Hyderabad: Cardiology Society of India; 2007.