Coronary Artery Disease Incidence

  • Data for CAD (coronary artery disease) incidence in Asian Indians is sparse but was consistently and substantially higher than compatriots of other ethnic origins.1-3
  • The incidence rate of heart disease, in contrast to prevalence, is the number of new cases diagnosed each year or over a given period of time. It is usually the number of people getting heart attack per 100,000 per year.4
  • In the 10-year prospective follow-up of the St. James Survey in Trinidad, the age-standardized CAD incidence in Asian Indians was 2-fold higher than Whites and 7-fold higher than blacks.2
  • In Singapore, where all heart attacks in the country are systematically entered in the registry, the incidence of heart attack has been 3-fold higher among Asian Indians than Chinese men and women.1, 5-7
  • In many countries, hospitalization for heart attacks in Asian Indians compared to other ethnic groups is 2 to 4-fold higher overall and 5 to 10-fold higher in those under 40 years of age.8-10
  • The 18-year follow-up of the Whitehall-II study showed South Asians had higher cumulative incidence of angina (chest pain) than Whites and was accompanied by a worse prognosis than Europids.11
  • The 17-year follow up of a cohort in UK showed death rate from CAD among South Asians was 2.2-fold higher than whites even when adjusted for age, smoking, cholesterol, blood pressure, insulin resistance, abdominal obesity, metabolic syndrome, diabetes, and socioeconomic status.3
  • In the US, the hospitalization for CAD among Asian Indians was 3.6 times higher than whites and 6 times higher than Chinese.12


1. Bee KS. The Health of Singaporeans. Singapore: Research and evaluation department, Ministry of Health;1993.

2. Miller GJ, Beckles GL, Maude GH, et al. 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(4):808-817.

3. 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.

4. Enas EA. How to Beat the Heart Disease Epidemic among South Asians: A Prevention and Management Guide for Asian Indians and their Doctors. Downers Grove: Advanced Heart Lipid Clinic  USA; 2011.

5. Hughes K. Coronary artery disease in Indians in Singapore. In: Sethi K, ed. Coronary artery disease in Indians – A Global perspective. Mumbai: Cardiological Society of India; 1998:56-62.

6. Lee J, Heng D, Chia KS, Chew SK, Tan BY, Hughes K. Risk factors and incident coronary heart disease in Chinese, Malay and Asian Indian males: the Singapore Cardiovascular Cohort Study. Int J Epidemiol. 2001;30(5):983-988.

7.  Heng DM, Lee J, Chew SK, Tan BY, Hughes K, Chia KS. Incidence of ischaemic heart disease and stroke in Chinese, Malays and Indians in Singapore: Singapore Cardiovascular Cohort Study. Ann Acad Med Singapore. 2000;29(2):231-236.

8. Klapholz M, Maurer M, Lowe AM, et al. Hospitalization for heart failure in the presence of a normal left ventricular ejection fraction: results of the New York Heart Failure Registry. J Am Coll Cardiol. Apr 21 2004;43(8):1432-1438.

9. Hughes LO, Raval U, Raftery E. First myocardial infarctions in Asian and White men. BMJ. 1989;298:1345-1350.

10. Hughes K, Yeo PP, Lun KC, et al. Cardiovascular diseases in Chinese, Malays, and Indians in Singapore.  Differences in risk factor levels. J Epidemiol Community Health. 1990;44(1):24-35.

11. Zaman MJ, Shipley MJ, Stafford M, et al. Incidence and prognosis of angina pectoris in South Asians and Whites: 18 years of follow-up over seven phases in the Whitehall-II prospective cohort study. J Public Health (Oxf). Nov 2 2010.

12. Klatsky  AL, Tekawa I, Armstrong MA, Sidney S. The risk of hospitalization for ischemic heart disease among Asian Americans in northern California. Am J Public Health. Oct 1994;84(10):1672-1675.

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