South Asian Women and Heart Disease
- The overall heart disease rates among women in India is nearly as high as in men, despite low rates of smoking (<10%). Among the Indian diasporas, the excess burden of heart disease is greater among Indian women than men1-3 (Figure 028).4
- The three major South Asian populations ─ Indians, Pakistanis and Bangladeshis ─ have been extensively studied both separately and collectively in the UK where CAD rates have declined by 50% over the past 40 years.5
- The decline in CAD mortality had been slower among South Asians than Europids. As a result, the difference in heart disease mortality between South Asians and Europids has increased over the past 30 years. The increase in CAD mortality was greater among South Asian women than men.5
- These differences are much higher than those reported 30 years earlier and are because of lower rate of decline or an actual increase in CAD rates among South Asians.5
- In Singapore, CAD mortality among Asian Indian women 30-39 years of age is 8-fold higher than Chinese women of the same age.6 Asian Indian women in California had significantly higher proportional mortality rate for CAD (144 Asian Indians vs. 100 whites).7
- Angiographic studies in Indians have shown high prevalence of severe and extensive disease including three-vessel disease (40%) despite the fact that majority of these women (56%) were premenopausal .8 In a Canadian angiographic study, Asian Indian women were twice as likely to have left-main or 3-vessel CAD compared to white women.9
- The overall heart disease rates among South Asian women are as high as or higher than South Asian men, despite low rates of smoking. Atherogenic dyslipidemia characterized by high triglyceride and low HDL-C concentrations, which in turn is related to insulin resistance, is highly prevalent among Asian Indian women and appears to be a major contributor.10 Perhaps the strongest contributor is high levels of lipoprotein (a) found in 35-40% of Asian Indians worldwide.11
1. Barnett AH, Dixon AN, Bellary S, et al. Type 2 diabetes and cardiovascular risk in the UK south Asian community. Diabetologia. Oct 2006;49(10):2234-2246.
2. Enas EA. Coronary artery disease epidemic in Indians: a cause for alarm and call for action. J Indian Med Assoc. Nov 2000;98(11):694-695, 697-702.
3. Enas EA, Senthilkumar A, Juturu V, Gupta R. Coronary artery disease in women. Indian Heart J. May-Jun 2001;53(3):282-292.
4. www.heartstats.org. CHD Statistics. Mortality. 2011. Accessed July 15, 2011.
5. Harding S, Rosato M, Teyhan A. Trends for coronary heart disease and stroke mortality among migrants in England and Wales, 1979-2003: slow declines notable for some groups. Heart. Apr 2008;94(4):463-470.
6. 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.
7. Palaniappan L, Wang Y, Fortmann SP. Coronary heart disease mortality for six ethnic groups in California, 1990-2000. Ann Epidemiol. Aug 2004;14(7):499-506.
8. Dave TH, Wasir HS, Prabhakaran D, et al. Profile of coronary artery disease in Indian women: Correlation of clinical, non invasive and coronary angiographic findings. Indian Heart J. 1991;43(1):25-29.
9. Gupta M, Brister S. Is South Asian ethnicity an independent cardiovascular risk factor? Can J Cardiol. Mar 1 2006;22(3):193-197.
10. Palaniappan LP, Kwan AC, Abbasi F, Lamendola C, McLaughlin TL, Reaven GM. Lipoprotein abnormalities are associated with insulin resistance in South Asian Indian women. Metabolism. Jul 2007;56(7):899-904.
11. Enas EA, Chacko V, Senthilkumar A, Puthumana N, Mohan V. Elevated lipoprotein(a)–a genetic risk factor for premature vascular disease in people with and without standard risk factors: a review. Dis Mon. Jan 2006;52(1):5-50.