Heart Disease in the South Asian Community

Dr Zarrin Shaikh Cardiology Registrar

Heart Disease in the South Asian Community Importance of coronary heart disease Heart attacks explained South Asians and heart disease Current and future action

Why is Cardiovascular Disease so Important?

120,000 deaths a year Men: 1 in 4 Women: 1 in 6 Nearly all deaths are due to a heart attack Someone has a heart attack every two minutes

Why is Cardiovascular Disease so Important?

The UKs biggest killer Deaths by Cause - Men Deaths by Cause - Women

Other 16% Injuries and Poisoning 4% Respiratory Disease 12% Coronary Heart Disease 22% Stroke 9% Other Cancer 19% Other CVD Lung and 8% Bowel Cancer 10% Other 22% Coronary Heart Disease 16% Injuries and Poisoning 2% Stroke 13% Respiratory Disease 14% Other CVD Lung, Breast 9% Other Cancer and Bowel 13% Cancer 11%

Source: Coronary Heart Disease Statistics (2005 edition), British Heart Foundation, as at 2003.

Rates are Improving Death rates from coronary heart disease have been falling since 1970

30 20 10 0 90 80 70 60 50 40 70 72 74 76 78 80 82 84 86 88 90 92 94 96 98 '00 '02

Source: Coronary Heart Disease Statistics (2005 edition), British Heart Foundation, for people aged under 65, 1970-2002.

Ethnic Differences The difference in death rates between South Asians (Pakistanis, Indians, Bangladeshis and Sri-Lankans) and the rest of the population is increasing From 1971 to 1991, the mortality rate for 20 – 69 year olds fell by: UK population: 29% in men and 17% in women South Asians: 20% in men and 7% in women

Ethnic Differences Standardised mortality ratios for coronary heart disease by gender and country of birth, 1989/92, England and Wales

South Asia Caribbean West Africa East Africa All Ireland Scotland 0 50 100

Source: Coronary Heart Disease Statistics (2005 edition), British Heart Foundation.

150 200 Men Women

Ethnic Differences South Asians living in the UK have a higher premature death rate from CHD than average Men 46% higher Women 51% higher

Important Problem that Needs to be Tackled Correctly

Coronary Artery Disease: The Basics

Coronary Artery Plaques

Plaque Rupture

Acute Heart Attack

Mr S Mr S presented to our hospital with a 30 minute history of central, crushing chest pain Preliminary investigations suggested he was having a heart attack

Reperfusion - 1 ° PCI

Reperfusion - 1 ° PCI

Reperfusion - 1 ° PCI

Non-modifiable Male Older age Family history Race Risk Factors Modifiable Smoking High blood cholesterol High blood pressure Uncontrolled diabetes Physical inactivity Obesity or overweight Uncontrolled stress or anger Diet high in saturated fat and cholesterol Drinking too much alcohol

Why is Coronary Heart Disease so Common in South Asians?

Excess Exposure to Risk Factors Low HDL Elevated triglycerides Diabetes Lack of aerobic exercise Obesity Smoking More common in men Less common in all South Asian women

Greater Susceptibility Not been systematically studied Genetic differences Mismatch between fetal/early life metabolism and that in middle age Rapid change in some risk factors

Specific Risk Factors As yet unidentified Ghee and other cooking oils Salt Racism Insulin resistance Specific lipid abnormalities

Competing Causes Fewer competing causes Fewer cancer deaths

The Future is not Bleak

The Future is not Bleak Co-ordinated, vigorous response based on established principles and available evidence on effectiveness Addressed in the National Service Framework on coronary heart disease

The Future is not Bleak Department of health guide: – Cutting coronary heart disease in the South Asian community – Place the needs of the South Asian community at the heart of coronary heart disease prevention

The Future is not Bleak Specific initiatives GP exercise referral schemes LEAP – Local Exercise Action Pilots Walking the way to health Coriander club Birmingham food net Ealing coronary risk prevention programme

Useful Contacts British Heart Foundation www.bhf.org.uk

Diabetes UK www.diabetes.org.uk

Quit www.quit.org.uk

The South Asian Health Foundation www.sahf.org.uk

Muslim Health Network www.muslimhealthnetwork.org

Conclusion Important problem Rates of CHD are 50% higher in South Asian populations in the UK Important to modify risk factors

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