CVD in Second and Third Generation Immigrants
- CVD (cardiovascular disease) and its risk factors among immigrants are intermediate with that of country of origin and the country of residence. The disease pattern as well as the risk factor pattern blends with that of the adopted country within two to three generations. Asian Indians and other South Asians have been a singular exception with both patterns diverging instead of converging.1
- Differences in heart disease rates between Asian Indians and Europids have increased over the past 30 years in the UK (Figure 026), but narrowed in Canada, but remain unchanged in Singapore. This may be equally applicable to the second and third generations in these countries.2-4,5-9
- There has been significant decrease in the age standardized CAD mortality in both men and women in the UK between 1979 and 1999. There was significant increase among South Asians particularly women with Indian women having 90% higher mortality and Pakistani women having 145% higher mortality than Europid women (see CADI UK). In this figure 100 is taken as the standard for the whites for both the time periods to appreciate the relative increase or decrease in the South Asian populations.
- The prevalence of obesity and diabetes is higher in children from South Asia and physical activity is lower in young Asian Indians than in whites, even in those with a family history of CAD.10
- Younger second- and third-generation migrants from South Asia need to be targeted to ensure that adverse lifestyle factors are addressed as early as possible.10
- Diet, weight control, and exercise are all important issues that need to be repeatedly discussed from an early age. Such discussion needs to be culturally sensitive, and ideally the whole family needs to be involved.10
- Low birth weight (<2500 g) has been thought of as a risk factor for the development of heart disease and diabetes in adult life. Although the mean birth weight of the South Asian newborns was 3133g it was significantly less than the national average and 8-12% of these newborns had a low birth weight. There has not been any increase in the average birth weight over the past 40 years, and the birth weight of babies of women who were born in the UK are no greater. The persistence of lower than desirable birth weight may result in long-term, higher than average rates of diabetes and heart disease in these groups.11
- A study in the Netherlands has demonstrated the persistence of an unfavorable cardiovascular risk profile in young, third to seventh generation migrated Asian Indians (n= 1790, mean age 36) compared to Europids. Prevalence of most of the conventional and modifiable cardiovascular risk factors was higher in Asian Indians compared to the Dutch. Asian Indians had higher levels of total cholesterol, LDL-C, triglycerides, and lower HDL-C levels than the Dutch.12
- Glucose intolerance was 14 times higher in men and 4 times higher in women. The prevalence of both obesity and central obesity was double in Asian Indian women.12
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