Australia
- Asian Indians in Australia not only have higher rates of CAD (coronary artery disease) but have higher risk of CAD at a given level of modifiable risk factors. This recognition has led to specific modifications to New Zealand Australian guidelines for the evaluation and treatment of blood pressure, cholesterol, and CAD among Asian Indians.1, 2
- Asian Indians are evaluated for CAD risk 10 years earlier than Europids in Australia and New Zealand, in recognition of their heightened risk at a very young age.1, 2
- Asian Indians are treated for high cholesterol and high blood pressure at a lower threshold than Europids. A 10 year CAD risk of 10% qualify for treatment among Asian Indians as opposed to 20% risk among Europids.1, 2
- Increasing HDL-cholesterol was associated with decreasing atherosclerosis (as measured by carotid intimal medial thickness) in the Australian population but the reverse was true for the Indian population (p<0.001) possibly due to dysfunctional HDL.3
- Greater adverse effects of total cholesterol and diabetes on atherosclerosis and no protective effect of HDL-cholesterol amongst Asian Indians compared to Europid Australians provide a novel possible explanation for observed excess rates of cardiovascular disease amongst Asian Indians.3
- A study comparing Indians in Australia and their siblings in India found that the group in Australia (especially women) had a more favorable disease risk profile than those in India. Women in India had lower BMI, but higher abdominal obesity (% WHR >0.8, 73 vs 23%) higher insulin (182 vs 90 pmol/l). Men in India had lower obesity and abdominal obesity but higher Insulin levels (137 vs 76 pmol/l).4
- The fact that the groups are of such similar background and partly related, make it unlikely that changes due to migration have a strong genetic bias. In contrast to other studies, the absence here of excessive weight gain on migration may be a key factor in disease risk prevention.
Sources
1. Enas EA, Singh V, Gupta R, Patel R, et al. Recommendations of the Second Indo-US Health Summit for the prevention and control of cardiovascular disease among Asian Indians. Indian Heart J. 2009;61:265-74.
2. New Zealand Cardiovascular Guidelines: Best Practice Evidence-based Guideline: The Assessment and Management of Cardiovascular Risk December 2003 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1904419/ accessed July 13, 2011.
3. Chow CK, McQuillan B, Raju PK, et al. Greater adverse effects of cholesterol and diabetes on carotid intima-media thickness in South Asian Indians: comparison of risk factor-IMT associations in two population-based surveys. Atherosclerosis. Jul 2008;199(1):116-122.
4. Mahajan D, Bermingham MA. Risk factors for coronary heart disease in two similar Indian population groups, one residing in India, and the other in Sydney, Australia. Eur J Clin Nutr. May 2004;58(5):751-760.