September 19, 2008 (Munich, Germany)— A new prospective British study has found that Indian Asians with acute coronary syndrome presenting to a chest pain clinic were, on average, almost 10 years younger than white Europeans presenting for the same reason, and they also had a much higher incidence of triple-vessel disease not explained by conventional risk factors. Dr Anoop Mansoor (Imperial College, London, UK) presented the results in a poster at the recent European Society of Cardiology Congress 2008.
Mansoor told heartwire the findings indicate that large-scale screening of Indian Asians is needed "from a young age, so that we can stop premature disease." Currently, UK recommendations stipulate that screening should begin in the general population from the age of 40 onward, he says, so he believes that Indian Asians should be screened from the age of 30. "Even though the average age of Indian Asian patients we saw was 60, the disease starts much younger, and we have even seen a number of patients in their 20s who come in with severe coronary artery disease," he said.
Such people should be screened for all conventional risk factors, particularly diabetes, which is especially prevalent in this population, he noted, and they should be given treatment where necessary and advice on lifestyle modifications.
More Triple-Vessel Disease in South Asians Is "Perplexing"
Mansoor said his team decided to conduct the study because the reasons underlying the twofold higher CAD mortality in Indian Asians compared with European whites is not known. Also, "there were no recent studies in an Indian Asian population with modern treatment anywhere in the literature, so we decided to take a prospective look and compare Indian Asians with whites as they came in to a day-to-day clinical practice."
They followed 584 patients with ACS admitted to a chest pain clinic at Ealing hospital in west London from May 2005 to July 2007, comprising 327 patients of Indian Asian origin (from the Indian subcontinent--India, Pakistan, and Bangladesh--or Sri Lanka) and 257 white Europeans. Over 60% of patients of both ethnic backgrounds were male.
The Indians were, on average, 63 years of age compared with 70.7 years for the whites (p<0.001).
They also had significantly increased prevalence of diabetes (odds ratio 3.4, p<0.001), dyslipidemia (OR 1.8, p=0.01), hypertension (OR 1.7, p=0.05), and history of CAD (OR 1.7, p=0.01) compared with European whites, adjusted for age and sex. Indian Asian patients had much lower smoking rates than the whites, however (OR 0.14, p<0.001).
And triple-vessel disease was more common in the Indian Asians than in the whites (17% vs 11%; p=0.009), and in regression analysis this was not accounted for by the higher prevalence of conventional cardiovascular risk factors in Indian Asians (p=0.02), a finding Mansoor said was "quite perplexing."
There were no differences in hospital use of coronary angiography, PCI, and CABG between the two populations.
"Indian Asians with ACS present almost 10 years earlier and have more extensive angiographic CAD than European whites," Mansoor concluded, adding that the reasons underlying this remain to be identified. "Large-scale prospective data comparing outcomes of ACS in Indian Asians and European whites are urgently required."
Public Information Campaign Needed
In the meantime, Mansoor said a public information campaign directed at young Indian Asians is needed. This is particularly true of young men who are "not overweight--to the contrary, they have quite active lifestyles so they do not see themselves as at risk."
The pattern of ACS seen in Indian Asian women was similar to that seen in whites, he noted; that is, they presented on average 10 years later than Indian Asian men, but this was still 10 years earlier than white women.
Heartwire from Medscape © 2008 Medscape
Cite this: Indian Asians With ACS Present Younger, Have More Aggressive Disease - Medscape - Sep 19, 2008.