South Asians and Anglo Australians with heart disease in Australia
Sabrina Gupta A B E , Rosalie Aroni A , Siobhan Lockwood C , Indra Jayasuriya D and Helena Teede D
+ Author Affiliations
- Author Affiliations
A Health Services Management Unit, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Level 3 Burnet Tower (Alfred Hospital), 89 Commercial Road, Melbourne, Vic. 3004, Australia. Email: Rosalie.Aroni@monash.edu
B Department of Public Health, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Vic. 3086, Australia.
C Monash HEART, Southern Health, Melbourne, Vic., Australia. Email: siobhanlockwood77@gmail.com
D Department of Diabetes, Southern Health, Melbourne, Vic., Australia. Email: indrajayasuriya@hotmail.com; Helena.Teede@monash.edu
E Corresponding author. Email: s.gupta@latrobe.edu.au
Australian Health Review 39(5) 568-576 https://doi.org/10.1071/AH14254
Submitted: 14 January 2015 Accepted: 17 April 2015 Published: 30 June 2015
Abstract
Objectives The aim of the present study was to determine cardiovascular disease (CVD) risk factors and compare presentation and severity of ischaemic heart disease (IHD) among South Asians (SAs) and Anglo Australians (AAs).
Methods A retrospective clinical case audit was conducted at a public tertiary hospital. The study population included SA and AA patients hospitalised for IHD. Baseline characteristics, evidence of diabetes and other CVD risk factors were recorded. Angiography data were also included to determine severity, and these were assessed using a modified Gensini score.
Results SAs had lower mean (± s.d.) age of IHD presentation that AAs (52 ± 9 vs 55 ± 9 years, respectively; P = 0.02), as well as a lower average body mass index (BMI; 26 ± 4 vs 29 ± 6 kg/m2, respectively; P = 0.005), but a higher prevalence of type 2 diabetes (57% vs 31%, respectively; P = 0.001). No significant differences were found in coronary angiography parameters. There were no significant differences in the median (interquartile range) Gensini score between SAs and AAs (43.5 (27–75) vs 44 (26.5–68.5), respectively), median vessel score (1 (1–2) vs 2 (1–3), respectively) or multivessel score (37% (33/89) vs 54% (22/41), respectively).
Conclusions The findings show that in those with established IHD, cardiovascular risk factors, such as age at onset and BMI, differ between SAs and AAs and these differences should be considered in the prevention and management of IHD.
What is known about the topic? There is much evidence on CVD and SAs, it being a leading cause of mortality and morbidity for this population both in their home countries and in countries they have migrated to. Studies conducted in Western nations other than Australia have suggested a difference in the risk profiles and presentations of CVD among SA migrants compared with the host populations in developed countries. Although this pattern of cardiovascular risk factors among SAs has been well documented, there is insufficient knowledge about this population, currently the largest population of incoming migrants, and CVD in the Australian setting.
What does this paper add? This paper confirms that a similar pattern of CVD exists in Australia among SAs as does in other Western nations they have migrated to. The CVD pattern found in this population is that of an earlier age of onset at lower BMI compared with the host AA population, as well as a differing cardiovascular risk profile, with higher rates of type 2 diabetes and lower smoking rates. In addition, this study finds similar angiographic results for both the SAs and AAs; however, the SAs exhibit these similar angiographic patterns at younger ages.
What are the implications for practitioners? SAs in Australia represent a high cardiovascular risk group and should be targeted for more aggressive screening at younger ages. Appropriate preventative strategies should also be considered bearing in mind the differing risk factors for this population, namely low BMI and high rates of type 2 diabetes. More intensive treatment strategies should also be regarded by practitioners. Importantly, both policy makers and health professionals must consider that all these strategies should be culturally targeted and tailored to this population and not assume a ‘one-size fits all’ approach.
References
[1] Australian Bureau of Statistics (ABS). 3412.0 – Migration, Australia, 2013–14. Canberra: ABS; 2014. Available at: http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/3412.0Main+Features12013-14?OpenDocument [verified 3 March 2015].[2] Australian Government Department of Immigration and Border Protection. Australia’s migration trends 2012–13. Commonwealth of Australia; 2014; Available at: http://www.immi.gov.au/pub-res/Documents/statistics/migration-trends-2012-13.pdf [verified 3 March 2015].
[3] Gupta M, Singh N, Verma S. South Asians and cardiovascular risk: what clinicians should know. Circulation 2006; 113 e924–9.
| South Asians and cardiovascular risk: what clinicians should know.Crossref | GoogleScholarGoogle Scholar | 16801466PubMed |
[4] Australian Bureau of Statistics. National health survey: cardiovascular and related conditions, Australia. Catalogue no. 4372.01995. Available at: http://www.abs.gov.au/ausstats/abs@.nsf/mediareleasesbyReleaseDate/7F7C0924CA2A93B9CA2568A900136256?OpenDocument [verified 3 December 2014].
[5] Australian Institute of Health and Welfare (AIHW). Health care expenditure on cardiovascular diseases 2004–05. Cardiovascular disease series no. 30. Catalogue no. CVD 43. Canberra: AIHW; 2008.
[6] CATI (Computer Assisted Telephone Interviewing) Technical Reference Group. National public health partnership. Population health monitoring and surveillance: question development background paper. Cardiovascular disease in Australia 2003. Available at: http://www.health.vic.gov.au/archive/archive2014/nphp/catitrg/cvdbgpaper.pdf [verified 30 April 2015].
[7] Gupta R. Recent trends in coronary heart disease epidemiology in India. Indian Heart J 2008; 60 B4–18.
| 19359764PubMed |
[8] Gupta R, Joshi P, Mohan V, Reddy KS, Yusuf S. Epidemiology and causation of coronary heart disease and stroke in India. Heart 2008; 94 16–26.
| Epidemiology and causation of coronary heart disease and stroke in India.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2sjks1Gntw%3D%3D&md5=97960be2d8122b9660e763c83e17aafeCAS | 18083949PubMed |
[9] Mendis S, Ekanayake EMTKB. Prevalence of coronary heart disease and cardiovascular risk factors in middle aged males in a defined population in central Sri Lanka. Int J Cardiol 1994; 46 135–42.
| Prevalence of coronary heart disease and cardiovascular risk factors in middle aged males in a defined population in central Sri Lanka.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2M7htlGrtw%3D%3D&md5=748478bbdbef7f165e49d62496703906CAS | 7814162PubMed |
[10] Zaman MM, Yoshiikem N, Rouf MA, Syeed MH, Khan MRH, Haque S, Mahtab H, Tanaka H. Cardiovascular risk factors: distribution and prevalence in a rural population of Bangladesh. Eur J Cardiovasc Prev Rehabil 2001; 8 103–8.
| Cardiovascular risk factors: distribution and prevalence in a rural population of Bangladesh.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3MrhsFamsQ%3D%3D&md5=7de9bc49427ab82d1343215f7f774c59CAS |
[11] Patel JV, Vyas A, Cruickshank JK, Prabhakaran D, Hughes E, Reddy KS, Mackness MI, Bhatnagar D, Durrington PN. Impact of migration on coronary heart disease risk factors: comparison of Gujaratis in Britain and their contemporaries in villages of origin in India. Atherosclerosis 2006; 185 297–306.
| Impact of migration on coronary heart disease risk factors: comparison of Gujaratis in Britain and their contemporaries in villages of origin in India.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD28XitVKgsbk%3D&md5=f57ea35b05f8b9cc83202ab30f77993aCAS | 16005463PubMed |
[12] Anand S, Yusuf S, Vuksan V, Devanesen S, Teo K, Montague P, Kelemen L, Yi C, Lonn E, Gerstein H, Hegele RA, McQueen M. Differences in risk factors, atherosclerosis, and cardiovascular disease between ethnic groups in Canada: the Study of Health Assessment and Risk in Ethnic groups (SHARE). Lancet 2000; 356 279–84.
| Differences in risk factors, atherosclerosis, and cardiovascular disease between ethnic groups in Canada: the Study of Health Assessment and Risk in Ethnic groups (SHARE).Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3crht1Krsw%3D%3D&md5=f1576ac78d771bf510cddd9ece785c1cCAS | 11071182PubMed |
[13] Fischbacher CM, Bhopal R, Povey C, Steiner M, Chalmers J, Mueller G, Jamieson J, Knowles D. Record linked retrospective cohort study of 4.6 million people exploring ethnic variations in disease: myocardial infarction in South Asians. BMC Public Health 2007; 7 142
| Record linked retrospective cohort study of 4.6 million people exploring ethnic variations in disease: myocardial infarction in South Asians.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2sritVOmsQ%3D%3D&md5=91950a615c06915a4413b9d3405e2c92CAS | 17615055PubMed |
[14] Kandula N, Tirodkar M, Lauderdale D, Khurana N, Makoul G, Baker D. Knowledge gaps and misconceptions about coronary heart disease among U.S. South Asians. Am J Prev Med 2010; 38 439–42.
| Knowledge gaps and misconceptions about coronary heart disease among U.S. South Asians.Crossref | GoogleScholarGoogle Scholar | 20307813PubMed |
[15] Dassanayake J, Gurrin L, Payne WR, Sundararajan V, Dharmage SC. Cardiovascular disease risk in immigrants: what is the evidence and where are the gaps? Asia Pac J Public Health 2010; 23 882–95.
| Cardiovascular disease risk in immigrants: what is the evidence and where are the gaps?Crossref | GoogleScholarGoogle Scholar | 21159699PubMed |
[16] Dassanayake J, Dharmage SC, Gurrin L, Sundararajan V, Payne WR. Are immigrants at risk of heart disease in Australia? A systematic review. Aust Health Rev 2009; 33 479–91.
| Are immigrants at risk of heart disease in Australia? A systematic review.Crossref | GoogleScholarGoogle Scholar | 20128766PubMed |
[17] Dassanayake J, Gurrin L, Payne WR, Sundararajan V, Dharmage S. Is country of birth a risk factor for acute hospitalization for cardiovascular disease in Victoria, Australia? Asia Pac J Public Health 2011; 23 280–7.
| Is country of birth a risk factor for acute hospitalization for cardiovascular disease in Victoria, Australia?Crossref | GoogleScholarGoogle Scholar | 21490109PubMed |
[18] Australian Bureau of Statistics. National regional profile: past and future releases. Canberra: Commonwealth of Australia; 2013.
[19] Zaman MJ, Philipson P, Chen R, Farag A, Shipley M, Marmot MG, Timmis AD, Hemingway H. South Asians and coronary disease: is there discordance between effects on incidence and prognosis? Heart 2013; 99 729–36.
| South Asians and coronary disease: is there discordance between effects on incidence and prognosis?Crossref | GoogleScholarGoogle Scholar | 23406688PubMed |
[20] Young C, Coles A. Immigrants in Australia: a health profile. Women’s health, use of medical services, medication, lifestyle and chronic illness. Some findings from the 1989–90 National Health Survey. Canberra: Australian Institute of Health and Welfare Ethnic Health Series; 1992.
[21] Australian Institute of Health and Welfare (AIHW), Singh M, de Looper M. Australian health inequalities: birthplace. Canberra: AIHW; 2002.
[22] Singh RB, Tomlinson B, Thomas GN, Sharma R. Coronary artery disease and coronary risk factors: the South Asian paradox. J Nutr Environ Med 2001; 11 43–51.
| Coronary artery disease and coronary risk factors: the South Asian paradox.Crossref | GoogleScholarGoogle Scholar |
[23] White C. Suspected research fraud: difficulties of getting at the truth. BMJ 2005; 331 281–8.
| Suspected research fraud: difficulties of getting at the truth.Crossref | GoogleScholarGoogle Scholar | 16052022PubMed |
[24] Pella D, Thomas N, Tomlinson B, Singh RB. Prevention of coronary artery disease: the south Asian paradox. Lancet 2003; 361 79
| Prevention of coronary artery disease: the south Asian paradox.Crossref | GoogleScholarGoogle Scholar | 12517494PubMed |
[25] Gupta M, Singh N, Warsi M, Reiter M, Ali K. Canadian South Asians have more severe angiographic coronary disease than European Canadians despite having fewer risk factors. Can J Cardiol 2001; 17 226C
[26] Bhopal R, Unwin N, White M, Yallop J, Walker L, Alberti KG, Harland J, Patel S, Ahmad N, Turner C, Watson B, Kaur D, Kulkarni A, Laker M, Tavridou A. Heterogeneity of coronary heart disease risk factors in Indian, Pakistani, Bangladeshi, and European origin populations: cross sectional study. BMJ 1999; 319 215–20.
| Heterogeneity of coronary heart disease risk factors in Indian, Pakistani, Bangladeshi, and European origin populations: cross sectional study.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1Mzks1SntA%3D%3D&md5=07094d31e71185785b6f46972550d09fCAS | 10417082PubMed |
[27] Gupta M, Doobay A, Singh N, Anand S, Raja F, Mawji F, Kho J, Karavetian A, Yi Q, Yusuf S. Risk factors, hospital management and outcomes after acute myocardial infarction in South Asian Canadians and matched control subjects. CMAJ 2002; 166 717–22.
| 11944758PubMed |
[28] Hsieh H-F, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005; 15 1277–88.
| Three approaches to qualitative content analysis.Crossref | GoogleScholarGoogle Scholar | 16204405PubMed |
[29] National Centre for Classification in Health. International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification 6th edition ICD-10-AM, 6th edn. Canberra: Australian Institute of Health and Welfare; 2008. Available at: http://meteor.aihw.gov.au/content/index.phtml/itemId/360927 [verified 30 April 2015].
[30] Bhopal R. Is research into ethnicity and health racist, unsound, or important science? BMJ 1997; 314 1751
| Is research into ethnicity and health racist, unsound, or important science?Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2szks1Sruw%3D%3D&md5=5ae3290aebd67dae07f4e0c47ae43415CAS | 9202509PubMed |
[31] Gunaratnam Y. Researching ‘race’ and ethnicity: methods, knowledge and power. London: SAGE Publications; 2003.
[32] Abouzeid M, Bhopal RS, Dunbar JA, Janus ED. The potential for measuring ethnicity and health in a multicultural milieu: the case of type 2 diabetes in Australia. Ethn Health 2013;
| The potential for measuring ethnicity and health in a multicultural milieu: the case of type 2 diabetes in Australia.Crossref | GoogleScholarGoogle Scholar | 23961834PubMed |
[33] United Nations Statistics Division. Composition of macro geographical (continental) regions, geographical sub-regions, and selected economic and other groupings. 2009. Available at: http://unstats.un.org/unsd/methods/m49/m49regin.htm#asia [verified 30 April 2015].
[34] Tillin T, Forouhi N, Johnston DG, McKeigue PM, Chaturvedi N, Godsland IF. Metabolic syndrome and coronary heart disease in South Asians, African-Caribbeans and white Europeans: a UK population-based cross-sectional study. Diabetologia 2005; 48 649–56.
| Metabolic syndrome and coronary heart disease in South Asians, African-Caribbeans and white Europeans: a UK population-based cross-sectional study.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2M3lslaqtw%3D%3D&md5=5cb72e93bfa2ddf8f4551c425381b384CAS | 15759110PubMed |
[35] Whitty CJM, Brunner EJ, Shipley MJ, Hemingway H, Marmot MG. Differences in biological risk factors for cardiovascular disease between three ethnic groups in the Whitehall II study. Atherosclerosis 1999; 142 279–86.
| Differences in biological risk factors for cardiovascular disease between three ethnic groups in the Whitehall II study.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DyaK1MXivVWisA%3D%3D&md5=6ddf494e5003be33640228ac641f3595CAS |
[36] Mateos P. A review of name-based ethnicity classification methods and their potential in population studies. Popul Space Place 2007; 13 243–63.
| A review of name-based ethnicity classification methods and their potential in population studies.Crossref | GoogleScholarGoogle Scholar |
[37] Wilkinson P, Sayer J, Laji K, Grundy C, Marchant B, Kopelman P, Timmis AD. Comparison of case fatality in South Asian and White patients after acute myocardial infarction: observational study. BMJ 1996; 312 1330–3.
| Comparison of case fatality in South Asian and White patients after acute myocardial infarction: observational study.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK283jtlCgtQ%3D%3D&md5=f327f5c76cefc1c1f22b3bead04655d5CAS | 8646044PubMed |
[38] Sinning C, Lillpopp L, Appelbaum S, Ojeda F, Zeller T, Schnabel R, Lubos E, Jagodzinski A, Keller T, Munzel T, Bickel C, Blankenberg S. Angiographic score assessment improves cardiovascular risk prediction: the clinical value of SYNTAX and Gensini application. Clin Res Cardiol 2013; 102 495–503.
| Angiographic score assessment improves cardiovascular risk prediction: the clinical value of SYNTAX and Gensini application.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3sXhtVyrtb%2FJ&md5=82daae6aacf255cf4848c1f1df2a5d6aCAS | 23519584PubMed |
[39] Gensini GG. A more meaningful scoring system for determining the severity of coronary heart disease. Am J Cardiol 1983; 51 606
| A more meaningful scoring system for determining the severity of coronary heart disease.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaL3s7itlyitw%3D%3D&md5=31475d3f23510cbc0fde37d06d8dcc71CAS | 6823874PubMed |
[40] Joshi P, Islam S, Pais P, Reddy S, Dorairaj P, Kazmi K, Pandey MR, Haque S, Mendis S, Rangarajan S, Yusuf S. Risk factors for early myocardial infarction in South Asians compared with individuals in other countries. JAMA 2007; 297 286–94.
| Risk factors for early myocardial infarction in South Asians compared with individuals in other countries.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2sXotVClsg%3D%3D&md5=6068662f1f963e17616841dae8a7688bCAS | 17227980PubMed |
[41] Singh RB, Niaz MA, Ghosh S, Beegom R, Agarwal P, Nangia S, Moshiri M, Janus ED. Low fat intake and coronary artery disease in a population with higher prevalence of coronary artery disease: the Indian paradox. J Am Coll Nutr 1998; 17 342–50.
| Low fat intake and coronary artery disease in a population with higher prevalence of coronary artery disease: the Indian paradox.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1czns1OjsA%3D%3D&md5=daaa997b9eba0e0f52c95f48afa2623aCAS | 9710843PubMed |
[42] Tillin T, Hughes A, Mayet J, Whincup P, Sattar N, Forouhi N, McKeigue PM, Chaturvedi N. The relationship between metabolic risk factors and incident cardiovascular disease in Europeans, South Asians, and African Caribbeans: SABRE (Southall and Brent Revisited), a prospective population-based study. J Am Coll Cardiol 2013; 61 1777–86.
| The relationship between metabolic risk factors and incident cardiovascular disease in Europeans, South Asians, and African Caribbeans: SABRE (Southall and Brent Revisited), a prospective population-based study.Crossref | GoogleScholarGoogle Scholar | 23500273PubMed |
[43] Chadha SL, Radhakrishnan S, Ramachandran K, Kaul U, Gopinath N. Epidemiological study of coronary heart disease in urban population of Delhi. Indian J Med Res 1990; 92 424–30.
| 1:STN:280:DyaK3M7nslGltw%3D%3D&md5=c943456d1b72132157a40110581e2952CAS | 2079357PubMed |
[44] Pais P, Pogue J, Gerstein H, Zachariah E, Savitha D, Jayprakash S, Nayak PR, Yusuf S. Risk factors for acute myocardial infarction in Indians: a case-control study. Lancet 1996; 348 358–63.
| Risk factors for acute myocardial infarction in Indians: a case-control study.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK28zit1ahug%3D%3D&md5=d83f7049e58dcad8a93007e3a733d2f4CAS | 8709733PubMed |
[45] Chiu M, Austin PC, Manuel DG, Tu JV. Comparison of cardiovascular risk profiles among ethnic groups using population health surveys between 1996 and 2007. CMAJ 2010; 182 E301–10.
| Comparison of cardiovascular risk profiles among ethnic groups using population health surveys between 1996 and 2007.Crossref | GoogleScholarGoogle Scholar | 20403888PubMed |
[46] Derry C, Bourne D, Sayed A, Disler PB, Rip MR, Taylor SP, Whittaker S, Klopper JM, Epstein L. Variations in mortality of the Coloured, White and Asian population groups in the RSA, 1978–1982. VI. Ischaemic heart disease. S Afr Med J 1987; 72 698–700.
| 1:STN:280:DyaL1c%2FntFSltg%3D%3D&md5=a70abdaae327f2ba79cd722739176aeaCAS | 3686267PubMed |
[47] Gupta M, Brister S. Is South Asian ethnicity an independent cardiovascular risk factor? Can J Cardiol 2006; 22 193–7.
| Is South Asian ethnicity an independent cardiovascular risk factor?Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD28XjsFahtLk%3D&md5=423f057ab4fac52b223800ad7eb3a182CAS | 16520847PubMed |
[48] Hughes K, Lun K, Yeo P. Cardiovascular diseases in Chinese, Malays, and Indians in Singapore. I. Differences in mortality. J Epidemiol Community Health 1990; 44 24–8.
| Cardiovascular diseases in Chinese, Malays, and Indians in Singapore. I. Differences in mortality.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK3c3ntVOqsg%3D%3D&md5=1a18630d311de006f2f1bcdb0469f9cdCAS | 2348144PubMed |
[49] McKeigue PM, Miller GJ, Marmot MG. Coronary heart disease in South Asians overseas: a review. J Clin Epidemiol 1989; 42 597–609.
| Coronary heart disease in South Asians overseas: a review.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaL1MzktFyntQ%3D%3D&md5=a9e1aaf00b00dd2771f585fed2cbf790CAS | 2668448PubMed |
[50] Miller G, Beckles G, Maude G, Carson D, Alexis S, Price S, Byam NTA. Ethnicity and other characteristics predictive of coronary heart disease in a developing community: principal results of the St. James survey, Trinidad. Int J Epidemiol 1989; 18 808–17.
| Ethnicity and other characteristics predictive of coronary heart disease in a developing community: principal results of the St. James survey, Trinidad.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK3c7ltlSiuw%3D%3D&md5=e9e51121f6b186a348533438929a8dc4CAS | 2621016PubMed |
[51] Tuomilehto J, Li N, Dowse G, Gareeboo H, Chitson P, Fareed D, Min Z, Alberti KGMM, Zimmet P. The prevalence of coronary heart disease in the multi-ethnic and high diabetes prevalence population of Mauritius. J Intern Med 1993; 233 187–94.
| The prevalence of coronary heart disease in the multi-ethnic and high diabetes prevalence population of Mauritius.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK3s7mtlOmug%3D%3D&md5=a1548876a6b906a9cf7f7eb426ad6facCAS | 8433080PubMed |
[52] Wild S, Laws A, Fortmann S, Varady A, Byrne C. Mortality from coronary heart disease and stroke for six ethnic groups in California, 1985–1990. Ann Epidemiol 1995; 5 432–9.
| Mortality from coronary heart disease and stroke for six ethnic groups in California, 1985–1990.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK283osleltg%3D%3D&md5=ead094a74df9ac9f84a8b4a7202832b7CAS | 8680605PubMed |
[53] Bhattacharya G, Schoppelrey S. Preimmigration beliefs of life success, postimmigration experiences, and acculturative stress: South Asian immigrants in the United States. J Immigr Health 2004; 6 83–92.
| Preimmigration beliefs of life success, postimmigration experiences, and acculturative stress: South Asian immigrants in the United States.Crossref | GoogleScholarGoogle Scholar | 15014225PubMed |
[54] Enas E, Garg A, Davidson M, Nair V, Huet B, Yusuf S. Coronary heart disease and its risk factors in first-generation immigrant Asian Indians to the United States of America. Indian Heart J 1996; 48 343–53.
| 1:STN:280:DyaK2s%2FmsFaksw%3D%3D&md5=f2cbdb07ca9c06e2057a876fbe88d9a2CAS | 8908818PubMed |
[55] Mammi M, Pavithran P, Abdu , Rahiman P, Pisharody R, Sugathan . Acute MI in North Kerala. A 20-year hospital based study. Indian Heart J 1991; 43 93–6.
| 1:STN:280:DyaK38%2FptFSjsA%3D%3D&md5=5f2df1c7c15120774ccfd448d07f4b17CAS | 1752622PubMed |
[56] Scarborough P, Bhatnagar P, Kaur A, Smolina K, Wickramasinghe K, Rayner M. Ethnic differences in cardiovascular disease 2010. Oxford: British Heart Foundation Health Promotion Research Group, Department of Public Health, University of Oxford; 2010.
[57] Whincup P, Gilg J, Papacosta O, Seymour C, Miller G, Alberti K, Cook DG. Early evidence of ethnic differences in cardiovascular risk: cross sectional comparison of British South Asian and White children. BMJ 2002; 324 635–8.
| Early evidence of ethnic differences in cardiovascular risk: cross sectional comparison of British South Asian and White children.Crossref | GoogleScholarGoogle Scholar | 11895820PubMed |
[58] Mackay J, Mensah G. The atlas of heart disease and stroke. Geneva: World Health Organization; 2004.
[59] Nazroo JY. Genetic, cultural or socio-economic vulnerability? Explaining ethnic inequalities in health. Sociol Health Illn 1998; 20 710–30.
| Genetic, cultural or socio-economic vulnerability? Explaining ethnic inequalities in health.Crossref | GoogleScholarGoogle Scholar |
[60] Massey DS, Arango J, Hugo G, Kouaouci A, Pellegrino A, Taylor JE. Theories of international migration: a review and appraisal. Popul Dev Rev 1993; 19 431–66.
| Theories of international migration: a review and appraisal.Crossref | GoogleScholarGoogle Scholar |
[61] Greenhalgh T, Helman C, Chowdhury AM. Health beliefs and folk models of diabetes in British Bangladeshis: a qualitative study. BMJ 1998; 316 978–83.
| Health beliefs and folk models of diabetes in British Bangladeshis: a qualitative study.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1c3ht1eitw%3D%3D&md5=845457fccdfb65ca828c5e911af36db8CAS | 9550958PubMed |
[62] Jasso G, Massey DS, Rosenweig MR, Smith JP. Immigrant health: selectivity and acculturation. In: Anderson NB, Bulatao RA, Cohen B, editors. Critical perspectives on racial and ethnic differences in health in late life. Washington, DC: National Academies Press; 2004. Available at: http://www.ncbi.nlm.nih.gov/books/NBK25533/ [verified 30 April 2015].
[63] World Health Organization Study Group. Diet, nutrition and prevention of chronic diseases. Geneva: World Health Organization; 1990.
[64] Chandalia M, Lin P, Seenivasan T, Livingston EH, Snell PG, Grundy SM, Abate N. Insulin resistance and body fat distribution in South Asian men compared to Caucasian men. PLoS ONE 2007; 2 e812
| Insulin resistance and body fat distribution in South Asian men compared to Caucasian men.Crossref | GoogleScholarGoogle Scholar | 17726542PubMed |
[65] Sniderman A, Furberg CD, Keech A, Roeters van Lennep JE, Frohlich J, Jungner I, Walldius G. Apolipoproteins versus lipids as indices of coronary risk and as targets for statin treatment. Lancet 2003; 361 777–80.
| Apolipoproteins versus lipids as indices of coronary risk and as targets for statin treatment.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD3sXhs1WktL4%3D&md5=617c18fb9d5f72cf1edb7bf202741c77CAS | 12620753PubMed |
[66] Australian Bureau of Statistics. Customised report. national health survey 2007–08. Prevalence of cardiovascular disease for persons born in Southern Asian countries. Canberra: Commonwealth of Australia; 2010.
[67] Myers R, Kiely D, Cupples L, Kannel W. Parental history is an independent risk factor for coronary artery disease: the Framingham study. Am Heart J 1990; 120 963–9.
| Parental history is an independent risk factor for coronary artery disease: the Framingham study.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK3M%2Fit1elsw%3D%3D&md5=dbab7983c248d283f1e0f9b090e2783bCAS | 2220549PubMed |
[68] Forouhi N, Sattar N. CVD risk factors and ethnicity: a homogeneous relationship? Atheroscler Suppl 2006; 7 11–19.
| CVD risk factors and ethnicity: a homogeneous relationship?Crossref | GoogleScholarGoogle Scholar | 16500156PubMed |
[69] McKeigue PM, Shah B, Marmot MG. Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians. Lancet 1991; 337 382–6.
| Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK3M7isV2itw%3D%3D&md5=8364513df22a8972e3b2c1fe6ab87e3aCAS | 1671422PubMed |
[70] World Health Organization. The world health report 1995. Bridging the gaps. Report of the Director General. Geneva: World Health Organization; 1995.
[71] Tobacco Free Initiative. WHO global report on trends in tobacco smoking 2000–2025. World Health Organization. 2015. Available at: http://www.who.int/gho/tobacco/use/en/ [verified 1 May 2015].
[72] Bhopal R, Hayes L, White M, Unwin N, Harland J, Ayis S, Alberti G. Ethnic and socio-economic inequalities in coronary heart disease, diabetes and risk factors in Europeans and South Asians. J Public Health Med 2002; 24 95–105.
| Ethnic and socio-economic inequalities in coronary heart disease, diabetes and risk factors in Europeans and South Asians.Crossref | GoogleScholarGoogle Scholar | 12141592PubMed |
[73] World Health Organization Expert Consultation Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004; 363 157–63.
| Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies.Crossref | GoogleScholarGoogle Scholar | 14726171PubMed |
[74] Banerji MA, Faridi N, Atluri R, Chaiken RL, Lebovitz HE. Body composition, visceral fat, leptin, and insulin resistance in Asian Indian men. J Clin Endocrinol Metab 1999; 84 137–44.
| 1:CAS:528:DyaK1MXmslWlsA%3D%3D&md5=c7979cf7a46c51f0f9debf5be530cb60CAS | 9920074PubMed |
[75] Satia-Abouta J, Patterson RE, Neuhouser ML, Elder JP. Dietary acculturation: applications to nutrition research and dietetics. J Am Diet Assoc 2002; 102 1105–18.
| Dietary acculturation: applications to nutrition research and dietetics.Crossref | GoogleScholarGoogle Scholar | 12171455PubMed |
[76] Kelkar M. South Asian immigration in the United States: a gendered perspective. Harvard J Asian Am Policy Rev 2012; 22 55–60.
[77] Lindsay C. Profiles of ethnic communities in Canada: the South Asian community in Canada 2001. Ottawa: Statistics Canada; 2007.
[78] Office for National Statistics. Ethnicity and national identity in England and Wales 2011. 2012. Available at: http://www.ons.gov.uk/ons/rel/census/2011-census/key-statistics-for-local-authorities-in-england-and-wales/rpt-ethnicity.html#tab-Measuring-ethnicity- [verified 4 March 2015].
