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Diabetes and Heart Disease

Diabetes and CVD among Indians

  • South Asians may account for between 40-60% of global CVD burden within the next 10-15 years although they comprise less than 20% of the worlds population.1
  • The proportion of CAD patients with diabetes varies across countries, but approximately 15-21% of clinical trial and registry patients are documented as known diabetes patients.2, 3 India stands out as an anomaly with 30-39% of CAD patients reporting known diabetes in national and international prospective registries.3, 4
  • It appears that Indians are more susceptible to diabetes and CVD, and that these conditions are closely interlinked.5-7 In a study of non-diabetic subjects with acute coronary syndrome (heart attack with mean age 55 years), 46% had prediabetes, and 37% had diabetes with only 17%  having normal glucose tolerance.8
  • The risk for CAD is two to four times higher in diabetic subjects, and in Indians, CAD occurs prematurely, i.e., one to two decades earlier than in the West.9
  • Compared with people without diabetes Indians with diabetes have twice the CVD mortality, and 3-fold higher kidney and all-cause mortality.10, 11 Nearly one in 2 heart disease deaths among South Asians occur in individuals with diabetes compared to one in 8 among whites in the UK.12
  • Diabetes confers a substantially greater risk (3-4-fold higher) of heart attack and cardiac death among South Asians than in Europids (after adjustment for gender, age, educational level, smoking, hypertension, alcohol intake, and obesity).13-15
  • This heightened risk of CAD among South Asians with diabetes is in sharp contrast to the 32-44% lower risk observed among blacks, Hispanics, and other Asians.16, 17
  • Recent reports from the UK shows that the long-term mortality of Indian diabetic patents following a heart attack has been reduced to the same levels as whites possibly due to more aggressive management of the former.18 This may be in part to earlier treatment and lower threshold of treatment of South Asians as mandated by modification to guidelines.

Sources

1. Ali MK, Narayan KM, Tandon N. Diabetes & coronary heart disease: current perspectives. Indian J Med Res. Nov 2010;132(5):584-597.

2. McGuire DK, Emanuelsson H, Granger CB, et al. Influence of diabetes mellitus on clinical outcomes across the spectrum of acute coronary syndromes. Findings from the GUSTO-IIb study. GUSTO IIb Investigators. Eur Heart J. Nov 2000;21(21):1750-1758.

3. Prabhakaran D, Yusuf S, Mehta S, et al. Two-year outcomes in patients admitted with non-ST elevation acute coronary syndrome: results of the OASIS registry 1 and 2. Indian heart journal. May-Jun 2005;57(3):217-225.

4. Xavier  D, Pais P, Devereaux PJ, et al. Treatment and outcomes of acute coronary syndromes in India (CREATE): a prospective analysis of registry data. Lancet. Apr 26 2008;371(9622):1435-1442.

5. Enas EA, Mehta J. Malignant coronary artery disease in young Asian Indians: thoughts on pathogenesis, prevention, and therapy. Coronary Artery Disease in Asian Indians (CADI) Study. Clinical cardiology. Mar 1995;18(3):131-135.

6. 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.

7. Enas EA. Why is there an epidemic of malignant CAD in young Indians? Asian J Clin Cardiol. 1998;1:43-59.

8. Ramachandran  A, Chamukuttan S, Immaneni S, et al. High incidence of glucose intolerance in Asian-Indian subjects with acute coronary syndrome. Diabetes Care. Oct 2005;28(10):2492-2496.

9. Mohan V., Venkatraman JV, Pradeepa R. Epidemiology of cardiovascular disease in type 2 diabetes: the Indian scenario. J Diabetes Sci Technol. 2010;4(1):158-170.

10. Mohan V, Sandeep S, Deepa R, Shah B, Varghese C. Epidemiology of type 2 diabetes: Indian scenario. Indian J Med Res. Mar 2007;125(3):217-230.

11. Wilkinson P, Sayer J, Laji K, et al. Comparison of case fatality in south Asian and white patients after acute myocardial infarction: observational study. Bmj. 1996;312(7042):1330-1333.

12. 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.

13. Chaturvedi N, Fuller JH. Ethnic differences in mortality from cardiovascular disease in the UK: do they persist in people with diabetes? J Epidemiol Community Health. 1996;50(2):137-139.

14. Mather HM, Chaturvedi N, Fuller JH. Mortality and morbidity from diabetes in South Asians and Europeans: 11- year follow-up of the Southall Diabetes Survey, London, UK. Diabet Med. 1998;15(1):53-59.

15. Ma S, Cutter J, Tan CE, Chew SK, Tai ES. Associations of diabetes mellitus and ethnicity with mortality in a multiethnic Asian population: data from the 1992 Singapore National Health Survey. Am J Epidemiol. Sep 15 2003;158(6):543-552.

16. Karter AJ, Ferrara A, Liu JY, Moffet HH, Ackerson LM, Selby JV. Ethnic disparities in diabetic complications in an insured population. Jama. 2002;287(19):2519-2527.

17. Kamalesh  M, Subramanian U, Ariana A, Sawada S, Peterson E. Diabetes status and racial differences in post-myocardial infarction mortality. Am Heart J. Nov 2005;150(5):912-919.

18. Nijjar AP, Wang H, Dasgupta K, Rabi DM, Quan H, Khan NA. Outcomes in a diabetic population of South Asians and whites following hospitalization for acute myocardial infarction: a retrospective cohort study. Cardiovascular diabetology. 2010;9:4.

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