Heart disease in Asian people with diabetes

Type 2 diabetes is increased up to four‐fold in middle‐aged and older Indo‐Asian people, and associated with increased coronary heart disease (CHD), and premature morbidity and mortality. Seventy‐seven percent of deaths in Indo‐Asian people with diabetes were caused by cardiovascular disease compared with 46% European deaths, in the Southall Diabetes Survey. The Indo‐Asian communities have an increased inherited lipoprotein (a) level compared to white Europeans, whilst migration results in the unmasking of a cluster of cardiovascular risk factors incorporating central obesity, hyperinsulinaemia. type‐2 diabetes and dyslipidaemia. Conventional cardiovascular risk factors are important, and in India, current smoking, hypertension and overt diabetes mellitus are the strongest predictors of a first actute myocardial infarction (AMI). Hyperlipidaemia may have a less important causal role in an Indian setting, but the situation is likely to be different in a migratory Indo‐Asian population. Unfortunately there is a lamentable lack of intervention studies in Indo‐Asian diabetic people with CHD, and currently the evidence base from other populations needs to be extrapolated. The six month mortality in Indo‐Asian people post AMI is double the white European population, despite similar use of aspirin, thrombolysis and beta blockade. and is primarily due to the increase prevalence of diabetes. This stresses the importance of active treatment of all cardiovascular risk factors, including hyperglycaemia in the peri‐infarct period. Active health promotion addressing physical activity and modifying dietaary intake is crucial in the Indo‐Asian communities, and campaigns such as Project Dil in Leicestershire have incorporated both primary and secondary prevention. The extrapolated evidence base would suggest that early use of angiotensin‐converting enzyme inhibition, statin and/or fibrate therapy, and insulin therapy may all benefit Indo‐Asian diabetic people with CHD, while metformin should be the first‐line oral hypoglycaemic agent in most Indo‐Asian diabetic people without CHD. Copyright © 2001 John Wiley & Sons, Ltd.