Race, ethnicity, and heart disease: A challenge for cardiology for the 21st century

Despite health programs and modernization producing annual CHD mortality declines from 1991 to 1999, the CVD incidence and survival rate difference remained for Indians, Malays, and Chinese.12 South Asians, like many ethnic communities, are prone to CVD and diabetes, with 50% to 300% higher CVD incidence and mortality, CHD 5 to 10 years earlier and a more progressive course.1-14 This consistent pattern emerges despite diversity of origins, culture, customs, socioeconomic state, changing environments, and differing adaptation and assimilation.1-14 South Asians develop diabetes younger and with lower body mass index and waist size.7 One Canadian study shows they present to hospital later, with more anterior myocardial infarction and more significant left main, multivessel, and distal coronary artery disease.8 There is diversity in South Asian and ethnic subpopulations, with differing risk and disease patterns, including many without premature CVD.