Circulation, Vol 87, 152-161, Copyright © 1993 by American Heart Association
PM McKeigue, JE Ferrie, T Pierpoint and MG Marmot
BACKGROUND. Rates of coronary heart disease are higher in South Asians
(Indians, Pakistanis, and Bangladeshis) settled overseas than in other
ethnic groups. We tested the hypothesis that this excess risk results from
metabolic disturbances associated with insulin resistance. METHODS AND
RESULTS. There were 1,421 South Asian men and 1,515 European men aged 40-69
years in London examined in the Southall Study. Prevalence of ischemic ECG
abnormalities was higher in South Asians than in Europeans (17% versus 12%,
p < 0.001), with an excess of major Q waves (Minnesota codes 1-1 or 1-2)
in younger South Asian men (p = 0.01 for the age-ethnicity interaction).
Major Q waves were strongly associated with glucose intolerance and
hyperinsulinemia in younger South Asians; these factors accounted
statistically for 73% of major Q waves in those aged 40-54 years.
Age-standardized prevalence of a positive history of coronary heart disease
was similar in South Asians and Europeans (8.5% versus 8.2%, NS), and
positive history without Q waves was not associated with glucose
intolerance or hyperinsulinemia in South Asians. Smoking rates and average
plasma cholesterol were lower in South Asians than in Europeans; in a
logistic model controlling for smoking and cholesterol, the odds ratio for
major Q waves in South Asians compared with Europeans was 2.4 (95% CI,
1.5-3.8). Adjusting for glucose intolerance and hyperinsulinemia reduced
this ratio to 1.5 (95% CI, 0.9-2.5). CONCLUSIONS. These results are
consistent with the hypothesis that insulin resistance underlies the high
coronary risk in South Asian people and strengthen the evidence for a
fundamental role of this metabolic pattern in the etiology of coronary
heart disease.
ARTICLES
Association of early-onset coronary heart disease in South Asian men with glucose intolerance and hyperinsulinemia
Department of Epidemiology and Population Sciences, London School of Hygiene and Tropical Medicine, England.
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