South Asians originate from the Indian sub-continent and represent roughly one fifth of the world’s population. This ethnic group contributes to the highest proportion of coronary artery disease (CAD) burden, mainly attributed to the high prevalence of diabetes. However, other established and emerging risk factors are overrepresented in this population at a younger age. Further large scale research is needed to identify various genetic and environmental mechanisms underlying the increased diabetes and vascular risk in the South Asian population. Effective clinical strategies to reduce the risk of diabetes and CAD in the South Asian population are the need of the hour.
AnandSSYusufSVuksanV. Differences in risk factors, atherosclerosis, and cardiovascular disease between ethnic groups in Canada: the Study of Health Assessment and Risk in Ethnic groups (SHARE). Lancet2000; 356:279-84.
2.
IqbalRAnandSOunpuuS. INTERHEART Study Investigators. Dietary patterns and the risk of acute myocardial infarction in 52 countries: results of the INTERHEART study. Circulation2008; 118: 1929-37.
3.
KhuntiKSamaniNJ. CAD in people of south-Asian origin. Lancet2004; 364: 2077-8.
4.
RanjithNPegoraroRJNaidooDP. Demographic data and outcome of acute coronary syndrome in the South African Asian Indian population. Cardiovasc J S Afr2005; 16: 48-54.
5.
EnasEAMehtaJ. Malignant CAD in young Asian Indians: thoughts on pathogenesis, prevention, and therapy. CAD in Asian Indians (CADI) Study. Clin Cardiol1995; 18: 131-5.
6.
ChambersJCKoonerJS. Diabetes, insulin resistance and vascular disease among Indian Asians and Europeans. Semin Vasc Med2002; 2199-214.
7.
MatherHMChaturvediNFullerJH. Mortality and morbidity from diabetes in South Asians and Europeans: 11-year follow-up of the Southall Diabetes Survey, London, UK. Diabet Med1998; 15: 53-9.
8.
JoshiPIslamSPaisP. Risk factors for early myocardial infarction in South Asians compared with individuals in other countries. JAMA2007; 297: 286-94.
9.
HardingSRosatoMTeyhanA. Trends for CAD and stroke mortality among migrants in England and Wales, 1979–2003: slow declines notable for some groups. Heart2008; 94: 463-70.
10.
GuptaRJoshiPMohanV. Epidemiology and causation of CAD and stroke in India. Heart2008; 94: 16-26.
11.
AnjanaRMPradeepaRDeepaM. ICMR–INDIAB Collaborative Study Group. Prevalence of diabetes and prediabetes (impaired fasting glucose and/or impaired glucose tolerance) in urban and rural India: phase I results of the Indian Council of Medical Research-INdia DIABetes (ICMR-INDIAB) study. Diabetologia2011; 54: 3022-7.
12.
BhopalRUnwinNWhiteM. Heterogeneity of CAD risk factors in Indian, Pakistani, Bangladeshi, and European origin populations: cross sectional study. BMJ1999; 319: 215-20.
13.
MohanVDeepaRRaniSSPremalathaG. Chennai Urban Population Study (CUPS No.5). Prevalence of CAD and its relationship to lipids in a selected population in South India: The Chennai Urban Population Study (CUPS No. 5). J Am Coll Cardiol2001; 38: 682-7.
14.
YusufSHawkenSOunpuuS. INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case–control study. Lancet2004; 364: 937-52.
15.
BalarajanR. Ethnicity and variations in the nation’s health. Health Trends1995–1996; 27: 114-9.
16.
GillPSKaiJBhopalRSWildSHealth care needs assessments: Black and minority ethnic groups. In: RafteryJ (ed.). Health Care Needs Assessments. The Epidemiologically based Needs Assessment Review, third series. Abingdon: Radcliffe Medical Press Ltd, 2004.
17.
ForouhiNGSattarNTillinT. Do known risk factors explain the higher CAD mortality in South Asian compared with European men? Prospective follow-up of the Southall and Brent studies,UK. Diabetologia2006; 49: 2580-8.
18.
GuptaMDoobayAVSinghN. Risk factors, hospital management and outcomes after acute myocardial infarction in South Asian Canadians and matched control subjects. CMAJ2002; 166: 717-22.
19.
WilkinsonPSayerJLajiK. Comparison of case fatality in south Asian and white patients after acute myocardial infarction: observational study. BMJ1996; 312: 1330-3.
20.
JellingerPS. Metabolic consequences of hyperglycemia and insulin resistance. Clin Cornerstone2007; 8(suppl 7): S30-42.
21.
ShelgikarKMHockadayTDYajnikCS. Central rather than generalized obesity is related to hyperglycaemia in Asian Indian subjects. Diabet Med1991; 8: 712-7.
22.
YajnikCS. The lifecycle effects of nutrition and body size on adult adiposity, diabetes and cardiovascular disease. Obes Rev2002; 3: 217-24.
23.
GholapNDaviesMPatelK. Type 2 diabetes and cardiovascular disease in South Asians. Prim Care Diabetes2011; 5: 45-56.
24.
YajnikCSYudkinJS. The Y-Y paradox. Lancet2004; 363 :163.
25.
SandeepSGokulakrishnanKDeepaMMohanV. Insulin resistance is associated with increased cardiovascular risk in Asian Indians with normal glucose tolerance: the Chennai Urban Rural Epidemiology Study (CURES-66). J Assoc Physicians India2011; 59: 480-4.
26.
YajnikCSLubreeHGRegeSS. Adiposity and hyperinsulinemia in Indians are present at birth. J Clin Endocrinol Metab2002; 87: 5575-80.
27.
BhopalRS. A four-stage model explaining the higher risk of Type 2 diabetes mellitus in South Asians compared with European populations. Diabet Med2013; 30: 35-42.
28.
ZindrouDTaylorKMBaggerJP. Coronary artery size and disease in UK South Asian and Caucasian men. Eur J Cardiothorac Surg2006; 29: 492-5.
29.
KaimkhaniZAliMFaruquiAM. Coronary artery diameter in a cohort of adult Pakistani population. J Pak Med Assoc2004; 54 :258-61.
30.
LipGYRathoreVSKatiraRWatsonRDSinghSP. Do Indo-Asians have smaller coronary arteries?Postgrad Med J1999; 75: 463-6.
31.
DhawanJBrayCL. Are Asian coronary arteries smaller than Caucasian? A study on angiographic coronary artery size estimation during life. Int J Cardiol1995; 49: 267-9.
32.
TewariSKumarSKapoorA. Premature CAD in North India: an angiography study of 1971 patients. Indian Heart J2005; 57: 311-8.
33.
KoulaouzidisGNicollRCharisopoulouD. Aggressive and diffuse coronary calcification in South Asian angina patients compared to Caucasians with similar risk factors. Int J Cardiol. 2012Jun15 [Epub ahead of print].
34.
MagnusPBeagleholeR. The real contribution of the major risk factors to the coronary epidemics: time to end the ‘only-50%’ myth. Arch Intern Med2001; 161: 2657-60.
35.
RamachandranAMarySYamunaA. High prevalence of diabetes and cardiovascular risk factors associated with urbanization in India. Diabetes Care2008; 31: 893-8.
36.
FischbacherCMHuntSAlexanderL. How physically active are South Asians in the United Kingdom? A literature review. J Public Health (Oxf)2004; 26 :250-8.
37.
HayesLWhiteMUnwinN. Patterns of physical activity and relationship with risk markers for cardiovascular disease and diabetes in Indian, Pakistani, Bangladeshi and European adults in a UK population. J Public Health Med2002; 24: 170-8.
38.
BettiolHRonaRJChinnS. Variation in physical fitness between ethnic groups in nine year olds. Int J Epidemiol1999; 28: 281-6.
39.
WilliamsEDStamatakisEChandolaTHamerM. Assessment of physical activity levels in South Asians in the UK: findings from the Health Survey for England. J Epidemiol Community Health2011; 65: 517-21.
40.
WilliamsEDStamatakisEChandolaTHamerM. Physical activity behaviour and CAD mortality among South Asian people in the UK: an observational longitudinal study. Heart2011; 97: 655-9.
41.
LipGYLuscombeCMcCarryM. Ethnic differences in public health awareness, health perceptions and physical exercise: implications for heart disease prevention. Ethn Health1996; 1: 47-53.
42.
FarooqiANagraDEdgarTKhuntiK. Attitudes to lifestyle risk factors for CAD amongst South Asians in Leicester: a focus group study. Fam Pract2000; 17: 293-7.
43.
RosensonRSBrewerHBJrDavidsonWS. Cholesterol efflux and atheroprotection: advancing the concept of reverse cholesterol transport. Circulation2012; 125: 1905
44.
GuettierJMGeorgopoulosATsaiMY. Polymorphisms in the fatty acid-binding protein 2 and apolipoprotein C-III genes are associated with the metabolic syndrome and dyslipidemia in a South Indian population. J Clin Endocrinol Metab2005; 90: 1705-11.
45.
DodaniSKaurRReddyS. Can dysfunctional HDL explain high CAD risk in South Asians?Int J Cardiol2008; 129: 125-32.
46.
BrunzellJDSnidermanADAlbersJJKwiterovichPOJr. Apoproteins B and A-I and CAD in humans. Arteriosclerosis1984; 4: 79-83.
47.
NiculescuLSVlădicăMSimaAV. Association of APOA5 and APOC3 gene polymorphisms with plasma apolipoprotein A5 level in patients with metabolic syndrome. Biochem Biophys Res Commun2010; 391: 587-91.
48.
HenkhausRSDodaniSManzardoAMButlerMG. APOA1 gene polymorphisms in the South Asian immigrant population in the United States. Indian J Hum Genet2011; 17: 194-200.
49.
BoonMRKaramaliNSde GrootCJ. E-selectin is elevated in cord blood of South Asian neonates compared with Caucasian neonates. J Pediatr2012; 160: 844-8.
50.
CubbonRMMurgatroydSRFergusonC. Human exercise-induced circulating progenitor cell mobilization is nitric oxide-dependent and is blunted in South Asian men. Arterioscler Thromb Vasc Biol2010; 30: 878-84.
