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Why do South Asians have the highest rates of heart disease in the world?



People from South Asia – India, Pakistan, and Bangladesh – have more than half of the world’s heart disease patients. Why do South Asians have the highest rates of heart disease than people from other countries? Even if they leave their country, they remain at risk. For example, South Asian immigrants to the United States develop earlier and more malignant heart disease and have higher death rates than any other major ethnic group in America (New York Times, November 28, 2015).

People don’t know why. There is a ‘knowledge gap’ regarding the reasons for the high rates of cardiac disease amongst South Asians.

Research conduced in Massachusetts over the past 70 years, known as the Framingham Heart Study, may provide the answer. It is perhaps the most influential investigation in the history of modern medicine because it established that the traditional risk factors such as high blood pressure, diabetes, and smoking contribute to coronary heart disease. The Framingham study commenced in the 1940s when cardiovascular disease was the main cause of death in the United States, accounting for nearly half of all deaths. The aim of the study at the time was to establish risk factors for coronary heart disease. Their numerous studies (about 1,200 over the past 70 years) have shown the correlation between high blood pressure and heart disease, as well as correlations between heart disease and diabetes, high blood cholesterol levels, and cigarette smoking. However, there have been few definitive studies for non-white ethnic groups.

Risk studies in 1959 showed that the increased risk of premature heart disease in Indian immigrant males had four times the rate of heart disease compared with men in the Framingham study despite having lower rates of hypertension, smoking, and high cholesterol – and usually following a vegetarian diet. Why?

The National Institutes of Health (NIH) has commenced a study to find out why. It has enrolled about 900 South Asian men and women from two metropolitan areas – the San Francisco Bay area and Chicago – to participate in a study on heart disease. Researchers are focusing on novel risk factors including social, cultural, and genetic determinants. They are also focusing on malignant forms of cholesterol because previous research suggested that South Asians may have smaller and denser cholesterol particles that are more prone to causing hardening of the arteries than non-South Asians. Results will be published in the next couple of years.


http://www.nytimes.com/2015/11/29/opinion/sunday/the-heart-disease-conundrum.html?action=click&pgtype=Homepage&version=Moth-Visible&moduleDetail=inside-nyt-region-1&module=inside-nyt-region&region=inside-nyt-region&WT.nav=inside-nyt-region&_r=0
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