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Inayat S, Hayden KA, Campbell T, Shier KK. Barriers and Facilitators of Center-Based Cardiac Rehabilitation Utilization in South Asian Ethnic Minorities: A META-SYNTHESIS. J Cardiopulm Rehabil Prev 2024; 44:91-98. [PMID: 37947519 DOI: 10.1097/hcr.0000000000000822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
AIM The aim of this review was to synthesize literature on the perceptions of South Asian ethnic minorities of the barriers and facilitators to center-based, phase II cardiac rehabilitation (CR). METHODS A meta-synthesis approach was used, and findings were reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was conducted from database inception dates to July 2022 using the following databases: MEDLINE, EMBASE, APA PsycINFO, Cochrane Database of Systematic Review, CINAHL, Scopus, and Web of Science. The inclusion criteria were studies that examined the barriers and/or facilitators of structured center-based CR among South Asian adult ethnic minorities. Critical appraisal of the included studies was conducted using the Mixed Methods Appraisal Tool. Findings were synthesized using a thematic synthesis approach. RESULTS Among the 7110 records initially retrieved only nine studies conducted in the United Kingdom or Canada met the inclusion criteria. More barriers than facilitators were studied and reported. Key barriers were the English language difficulty, fatalistic beliefs, previous bad interactions with and negative perception of health care professionals, transportation problems, work schedule conflict, safety issues, and long-distance CR centers. The facilitators included patient-preferred environment, presence of family members during exercise, family and friends support, and encouragement to change lifestyle and enroll in a CR program. CONCLUSION The review findings revealed that South Asian ethnic minorities encounter various barriers and facilitators to enroll and complete CR. The findings can inform researchers and clinicians in the development of interventions that are tailored to their cultural needs. PRACTICE IMPLICATIONS The findings can be valuable to health care professionals and policy makers in designing customized CR programs for South Asian minorities.
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Affiliation(s)
- Shahzad Inayat
- Faculty of Nursing (Mr Inayat and Dr Shier), Libraries and Cultural Resources (Dr Hayden), and Department of Psychology (Dr Campbell), University of Calgary, Calgary, Alberta, Canada
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Norris CM, Mullen KA, Foulds HJ, Jaffer S, Nerenberg K, Gulati M, Parast N, Tegg N, Gonsalves CA, Grewal J, Hart D, Levinsson AL, Mulvagh SL. The Canadian Women's Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women - Chapter 7: Sex, Gender, and the Social Determinants of Health. CJC Open 2024; 6:205-219. [PMID: 38487069 PMCID: PMC10935698 DOI: 10.1016/j.cjco.2023.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/31/2023] [Indexed: 03/17/2024] Open
Abstract
Women vs men have major differences in terms of risk-factor profiles, social and environmental factors, clinical presentation, diagnosis, and treatment of cardiovascular disease. Women are more likely than men to experience health issues that are complex and multifactorial, often relating to disparities in access to care, risk-factor prevalence, sex-based biological differences, gender-related factors, and sociocultural factors. Furthermore, awareness of the intersectional nature and relationship of sociocultural determinants of health, including sex and gender factors, that influence access to care and health outcomes for women with cardiovascular disease remains elusive. This review summarizes literature that reports on under-recognized sex- and gender-related risk factors that intersect with psychosocial, economic, and cultural factors in the diagnosis, treatment, and outcomes of women's cardiovascular health.
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Affiliation(s)
- Colleen M. Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Kerri-Anne Mullen
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Heather J.A. Foulds
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Shahin Jaffer
- Department of Medicine/Community Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kara Nerenberg
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Martha Gulati
- Barbra Streisand Women’s Heart Centre, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Nazli Parast
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Nicole Tegg
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | | | - Jasmine Grewal
- Department of Medicine/Community Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donna Hart
- Canadian Women’s Heart Health Alliance, Ottawa, Ontario, Canada
| | | | - Sharon L. Mulvagh
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Lassi ZS, Singh A, Bhaumik S. Call for investing in understanding the health and well-being of South Asian migrants in Australia. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 43:101029. [PMID: 38333630 PMCID: PMC10851199 DOI: 10.1016/j.lanwpc.2024.101029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 01/23/2024] [Indexed: 02/10/2024]
Affiliation(s)
- Zohra S. Lassi
- Robinson Research Institute, University of Adelaide, Australia
- School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Australia
| | - Ankur Singh
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | - Soumyadeep Bhaumik
- Meta-research and Evidence Synthesis Unit, Health Systems Science, George Institute for Global Health, Sydney, Australia
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Mukherjee D, Moitra S, Gun P, Bera M, Dey-Biswas P, Mukherjee R. Comorbidity Profiling in Rural and Urban Population of West Bengal, India: Report From a Community-Based Primary Healthcare System. Cureus 2024; 16:e51436. [PMID: 38169631 PMCID: PMC10758112 DOI: 10.7759/cureus.51436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2023] [Indexed: 01/05/2024] Open
Abstract
Introduction The burden of non-communicable diseases (NCDs) is fast changing across the world, especially in the context of rapid urbanization, adoption of Western lifestyles, and an aging multi-morbid population. Over the last three decades, India has undergone a significant demographic and socioeconomic transition. For effective targeting of health system resources and services, it is essential to understand how the prevalence of NCDs varies among population groups across India. We set out to understand the distribution of NCDs and co-morbidities in urban and rural West Bengal. Methods As part of a service improvement project, data was collected from four urban and four rural community-based clinics across West Bengal, India. The reason for visiting the healthcare center was recorded as the primary diagnosis and co-morbidities were recorded per the Elixhauser comorbidity scoring criteria. Associations between all the demographic variables and NCDs were studied using the Poisson regression model and multivariate analysis. Demographic profile, co-morbidities, and Elixhauser comorbidity index were expressed as frequency (%), mean (standard deviation, SD), or median (interquartile range, IQR) as appropriate. Results We obtained data from 1244 patients of which 886 (71%) were from urban areas and 358 (29%) were from rural areas. Patients were mostly female (61%) and had a mean (SD) age of 53 (11) years. There was a positive correlation between living in an urban residence and age, body mass index (BMI), hypertension, cardiovascular disease (CVD), and respiratory disease. There was a positive correlation between CVD and age, male sex, living in an urban residence, and hypertension but did not correlate positively with diabetes. BMI positively correlated with living in an urban residence, hypertension, diabetes, and musculoskeletal disorders. We observed a significantly higher prevalence of musculoskeletal (p=0.002) and psychological diseases (p<0.001) in the rural population, while the prevalence of hypertension (p<0.001) and respiratory diseases among the participants living in urban areas was higher (p<0.001). There was no statistically significant difference in the prevalence of diabetes between urban and rural areas (p=0.38). In the multivariable analyses, we observed that increased age, being overweight, and living in urban areas were associated with hypertension (prevalence ratio (PR): 1.40, 1.30, and 1.30, respectively; all p-values <0.05). An interaction between sex and living area was associated with a lower prevalence of musculoskeletal diseases (PR: 0.34; 95%CI: 0.18-0.66), i.e., musculoskeletal diseases were less prevalent in males living in urban areas (p=0.002). Conclusion There is a rise in multimorbidity with changing demographic patterns and a narrowing of the urban-rural gap in disease distribution. More investment is required in risk factor prevention, screening, and treatment, with greater accessibility of healthcare resources for those in rural areas. Further work needs to be done to study the trends and distribution of NCDs in West Bengal to inform healthcare policy.
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Affiliation(s)
| | | | - Punyabrata Gun
- General Medicine, Swasthya Shiksha Nirman (Rational Medicine Network), Kolkata, IND
| | - Mrinmoy Bera
- General Medicine, Swasthya Shiksha Nirman (Rational Medicine Network), Kolkata, IND
| | - Piyali Dey-Biswas
- Epidemiology and Public Health, Swasthya Shiksha Nirman (Rational Medicine Network), Kolkata, IND
| | - Rahul Mukherjee
- Respiratory Medicine and Physiology, Birmingham Heartlands Hospital, Birmingham, GBR
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Kuchi Bhotla H, Meyyazhagan A, Pushparaj K, Pappuswamy M, Chaudhary A, Arumugam VA, Balasubramanian B, Ragu Varman D, Orlacchio A, Rengasamy KRR. Prevalence of Cardiovascular Diseases in South Asians: Scrutinizing Traditional Risk Factors and Newly Recognized Risk Factors Sarcopenia and Osteopenia/Osteoporosis. Curr Probl Cardiol 2024; 49:102071. [PMID: 37690535 DOI: 10.1016/j.cpcardiol.2023.102071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/04/2023] [Indexed: 09/12/2023]
Abstract
One of the primary reasons for complications and death worldwide are cardiovascular diseases (CVDs), with a death toll of approximately 18 million per year. CVDs include cardiomyopathy, hypertension, ischemic heart disease, coronary heart disease, myocardial infarction, heart attack, hearth failure, etc. Over 80% of the CVD mortality is recorded from lower and middle-income countries. Records from the past decade have highlighted the increase of CVDs among the South Asian populations, and the prime purpose of the review is to jot down the reasons for the steep spike in CVDs. Studies analyzing the causative factors for the increase of CVDs in South Asians are still to be verified. Apart from known predisposing and lifestyle factors, other emerging risk factors associated with CVDs, namely the musculoskeletal diseases sarcopenia and osteopenia, should be tracked to tackle research gaps in upcoming analyses. This requires loads of scientific efforts. With proper monitoring, the raising alarm that the CVD burden generates can be reduced. This review discusses the already established signs and recognizes important clues to the emerging etiology of CVDs in the Asian population and prevention measures to keep it at bay.
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Affiliation(s)
- Haripriya Kuchi Bhotla
- Department of Life Science, CHRIST (Deemed to be University), Bengaluru, Karnataka, India
| | - Arun Meyyazhagan
- Department of Life Science, CHRIST (Deemed to be University), Bengaluru, Karnataka, India; Dipartimento di Medicina e Chirurgia, Università di Perugia, Perugia, Italy
| | - Karthika Pushparaj
- Department of Zoology, School of Biosciences, Avinashilingam Institute for Home Science and Higher Education for Women, Coimbatore, Tamil Nadu, India
| | - Manikantan Pappuswamy
- Department of Life Science, CHRIST (Deemed to be University), Bengaluru, Karnataka, India
| | - Aditi Chaudhary
- Department of Life Science, CHRIST (Deemed to be University), Bengaluru, Karnataka, India
| | - Vijaya Anand Arumugam
- Department of Human Genetics and Molecular Biology, Bharathiar University, Coimbatore, Tamil Nadu, India
| | | | - Durairaj Ragu Varman
- Department of Pharmacology and Toxicology, School of Medicine, Virginia Commonwealth University, Richmond, VA
| | - Antonio Orlacchio
- Laboratorio di Neurogenetica, Centro Europeo di Ricerca sul Cervello (CERC), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Santa Lucia, Rome, Italy; Dipartimento di Medicina e Chirurgia, Università di Perugia, Perugia, Italy
| | - Kannan R R Rengasamy
- Laboratory of Natural Products and Medicinal Chemistry (LNPMC), Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS), Thandalam, Chennai, India.
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Muniyappa R, Narayanappa SBK. Disentangling Dual Threats: Premature Coronary Artery Disease and Early-Onset Type 2 Diabetes Mellitus in South Asians. J Endocr Soc 2023; 8:bvad167. [PMID: 38178904 PMCID: PMC10765382 DOI: 10.1210/jendso/bvad167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Indexed: 01/06/2024] Open
Abstract
South Asian individuals (SAs) face heightened risks of premature coronary artery disease (CAD) and early-onset type 2 diabetes mellitus (T2DM), with grave health, societal, and economic implications due to the region's dense population. Both conditions, influenced by cardiometabolic risk factors such as insulin resistance, hypertension, and central adiposity, manifest earlier and with unique thresholds in SAs. Epidemiological, demographic, nutritional, environmental, sociocultural, and economic transitions in SA have exacerbated the twin epidemic. The coupling of premature CAD and T2DM arises from increased obesity due to limited adipose storage, early-life undernutrition, distinct fat thresholds, reduced muscle mass, and a predisposition for hepatic fat accumulation from certain dietary choices cumulatively precipitating a decline in insulin sensitivity. As T2DM ensues, the β-cell adaptive responses are suboptimal, precipitating a transition from compensatory hyperinsulinemia to β-cell decompensation, underscoring a reduced functional β-cell reserve in SAs. This review delves into the interplay of these mechanisms and highlights a prediabetes endotype tied to elevated vascular risk. Deciphering these mechanistic interconnections promises to refine stratification paradigms, surpassing extant risk-prediction strategies.
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Affiliation(s)
- Ranganath Muniyappa
- Clinical Endocrine Section, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - Satish Babu K Narayanappa
- Department of Medicine, Sri Madhusudan Sai Institute of Medical Sciences and Research, Muddenahalli, Karnataka 562101, India
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Bhandari P. Prevalence of cardiovascular risk factors among Asian migrant workers in South Korea. PLoS One 2023; 18:e0288375. [PMID: 37428813 DOI: 10.1371/journal.pone.0288375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 06/24/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND The burden of non-communicable diseases is rapidly increasing among young adults in middle- and low-income countries. Asian migrant workers continue to be a significant contributor to South Korea's economy; however, their cardiovascular health is neglected. We explored the prevalence of cardiovascular risk factors among Asian migrant workers in South Korea. METHODS Cross-sectional survey, anthropometric measurements, blood pressure measurements, and biochemical tests including triglyceride, high-density lipoprotein, low-density lipoprotein, total cholesterol, fasting blood sugar, HbA1c, and C-reactive protein levels were conducted in 141 Asian migrant workers in South Korea. RESULTS The mean age of the participants was 31.3 (5.6) years. Of the participants, 14.8% were current smokers, and 47.5% consumed alcohol. The prevalence of overweight/obesity was 32.4%. The prevalence of hypertension and dyslipidemia were 51.2% and 64.6%, respectively. Of the participants, 98.5% had an increased waist circumference; elevated HbA1C and C-reactive protein was seen in 20.9% and 4.3%, respectively. The prevalence of metabolic syndrome was 5.5%. Clustering of two or more risk factors was seen in 45% of the participants. Factors associated with a high risk of cardiovascular diseases (clustering of two or more risk factors) were age (odds ratio 1.16, p < 0.01) and smoking (4.98, p < 0.05). CONCLUSION The prevalence of cardiovascular risk factors was alarmingly high among Asian migrant workers employed in South Korea. Efforts to mitigate and eliminate those risk factors are urgently required.
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Affiliation(s)
- Pratibha Bhandari
- School of Nursing and Midwifery, University of Technology Sydney, Sydney, New South Wales, Australia
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Meng Q, Yang J, Wang F, Li C, Sang G, Liu H, Shen D, Zhang J, Jiang S, Yusufu A, Du G. Development and External Validation of Nomogram to Identify Risk Factors for CHD in T2DM in the Population of Northwestern China. Diabetes Metab Syndr Obes 2023; 16:1271-1282. [PMID: 37168834 PMCID: PMC10166093 DOI: 10.2147/dmso.s404683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/30/2023] [Indexed: 05/13/2023] Open
Abstract
Purpose Cardiovascular disease is the leading cause of mortality in patients with type 2 diabetes mellitus (T2DM). This study aimed to develop and validate a nomogram for predicting the risk factors for coronary heart disease (CHD) in T2DM in the population of northwestern China. Patients and Methods The records of 2357 T2DM patients who were treated in the First Affiliated Hospital of Xinjiang Medical University from July 2021 to July 2022 were reviewed. After some data (n =239) were excluded, 2118 participants were included in the study and randomly divided into a training set (n =1483) and a validation set (n = 635) at a ratio of 3:1. Univariate and stepwise regression analysis was performed to screen risk factors and develop predictive models. The results of logistic regression are presented through a nomogram. The C-index, receiver operating characteristic (ROC) curve, calibration plot, and decision curve analysis (DCA) were employed to verify the distinction, calibration, and clinical practicality of the model. Results The stepwise logistic regression analysis suggested that independent factors in patients with T2DM combined with CHD were age, gender, hypertension (HTN), glycated hemoglobin (HbA1c), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), and Uygur, which were associated with the occurrence of CHD. The nomogram demonstrated good discrimination with a C-index of 0.771 (95% CI, 0.741, 0.800) in the training set and 0.785 (95% CI, 0.743, 0.828) in the validation set. The area under curve (AUC) of the ROC curves were 0.771 (95% CI, 0.741, 0.800) and 0.785 (95% CI, 0.743, 0.828) in the training and validation sets, respectively. The nomogram was well-calibrated. The DCA revealed that the nomogram was clinically valuable. Conclusion A nomogram based on 7 clinical characteristics was developed to predict CHD in patients with T2DM.
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Affiliation(s)
- Qi Meng
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, People’s Republic of China
- Department of Endocrinology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Jing Yang
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, People’s Republic of China
- Department of Endocrinology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Fei Wang
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, People’s Republic of China
- Department of Endocrinology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Cheng Li
- Laboratory Medicine Diagnostic Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Guoyao Sang
- Data Statistics and Analysis Center of Operation Management Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Hua Liu
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, People’s Republic of China
- Department of Endocrinology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Di Shen
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, People’s Republic of China
- Department of Endocrinology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Jinxia Zhang
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, People’s Republic of China
- Department of Endocrinology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Sheng Jiang
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, People’s Republic of China
- Department of Endocrinology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Aibibai Yusufu
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, People’s Republic of China
- Department of Endocrinology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Guoli Du
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, People’s Republic of China
- Department of Endocrinology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
- Correspondence: Guoli Du; Aibibai Yusufu, Department of Endocrinology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830000, People’s Republic of China, Email ;
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Rishworth A, Cao T, Niraula A, Wilson K. Health Care Use and Barriers to Care for Chronic Inflammatory Diseases (CID) among First and Second Generation South Asian Immigrant Children and Parents in Ontario Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14608. [PMID: 36361486 PMCID: PMC9655293 DOI: 10.3390/ijerph192114608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
Abstract
Although immigrants are disproportionately impacted by growing chronic inflammatory disease (CIDs) rates, yet suffer barriers to access health care, little attention has been given to their primary healthcare or specialist healthcare access as it relates to complex, chronic diseases in Canada, a country with universal health care. This study aims to investigate CID health care use and barriers to care among first- and second-generation immigrant South Asian children and parents in the Greater Toronto Area, Ontario. Drawing on analysis of 24 in depth interviews with children and parents (14 children, 10 parents), the results reveal that although CIDs disproportionately affects South Asian immigrants, they encounter health system, geographic, interpersonal, and knowledge barriers to access requisite care. These barriers exist despite participants having a GP, and are compounded further by limited familial systems, culturally insensitive care, and structural inequities that in some instances make parents choose between health access or other basic needs. Although all participants recognized the importance of specialized care, only 11 participants regularly accessed specialized care, creating new schisms in CID management. The findings suggest that a multisectoral approach that address individual and structural level socio-structural drivers of health inequities are needed to create more equitable healthcare access.
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Affiliation(s)
- Andrea Rishworth
- Department of Geography, Geomatics and Environment, Faculty Geography, University of Toronto Mississauga, Mississauga, ON L5L 1C6, Canada
| | - Tiffany Cao
- Department of Geography, Geomatics and Environment, Faculty Geography, University of Toronto Mississauga, Mississauga, ON L5L 1C6, Canada
| | - Ashika Niraula
- CERC in Migration and Integration, Toronto Metropolitan University, Toronto, ON M5B 2K3, Canada
| | - Kathi Wilson
- Department of Geography, Geomatics and Environment, Faculty Geography, University of Toronto Mississauga, Mississauga, ON L5L 1C6, Canada
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Patel M, Abatcha S, Uthman O. Ethnic differences between South Asians and White Caucasians in cardiovascular disease-related mortality in developed countries: a systematic literature review. Syst Rev 2022; 11:207. [PMID: 36176009 PMCID: PMC9520891 DOI: 10.1186/s13643-022-02079-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiovascular disease is the leading cause of death worldwide, with significantly worse mortality-related outcomes in ethnic minorities in developed countries. A systematic literature review and meta-analysis of observational studies was conducted to investigate cardiovascular disease-related mortality inequalities between South Asian and White Caucasian ethnic groups. METHODS Published studies on mortality between South Asians and Whites in developed countries were retrieved from MEDLINE, PubMed, Embase, Web of Science, and grey literature sources (inception-April 2021) and critically appraised using the Quality in Prognosis Studies tool. Bayesian random-effects meta-analyses were performed for both primary and secondary outcomes. Heterogeneity was determined using the I2 statistic. RESULTS Of the 9879 studies screened originally, 41 were deemed eligible. A further 3 studies were included via the later search. Of these, 15 reported cardiovascular disease-related mortality, 23 reported all-cause mortality, and 6 reported both. The meta-analysis results showed that South Asians had a significantly increased risk of cardiovascular disease mortality compared to Whites (risk ratio = 1.32; 95% credible interval = 1.14 to 1.54) and a decreased risk of all-cause mortality (risk ratio = 0.95; 95% credible interval = 0.83 to 1.12). DISCUSSION South Asians had statistically significantly higher odds of cardiovascular disease-related mortality compared to Whites, but not for all-cause mortality. Risk of bias was a serious concern mainly due to a lack of confounders being reported. SYSTEMATIC REVIEW REGISTRATION PROSPERO: CRD42021240865.
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Affiliation(s)
- Mubarak Patel
- Warwick Evidence, Warwick Medical School (WMS), University of Warwick, Coventry, CV47AL, UK.
| | - Salim Abatcha
- Warwick Medical School (WMS), University of Warwick, Coventry, CV47AL, UK
| | - Olalekan Uthman
- Warwick Medical School (WMS), University of Warwick, Coventry, CV47AL, UK
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Temple J, Wilson T, Brijnath B, Radford K, LoGiudice D, Utomo A, Anstey KJ. The role of demographic change in explaining the growth of Australia's older migrant population living with dementia, 2016-2051. Aust N Z J Public Health 2022; 46:661-667. [PMID: 36047851 DOI: 10.1111/1753-6405.13276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 05/01/2022] [Accepted: 05/01/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To examine the demographic drivers contributing to the future growth in the population of older migrants in Australia living with dementia. METHODS Using birthplace-specific cohort-component projection models, we projected the number of older migrants living with dementia. ABS data on births, deaths, migration and birthplace were used, alongside Australian Institute of Health and Welfare (AIHW) estimates of dementia prevalence with birthplace dementia weights calculated from administrative data. RESULTS The number of older migrants living with dementia is projected to increase from about 134,423 in 2016 to 378,724 by 2051. Increases in populations with dementia varied considerably, from a slight decrease for those born in Southern & Eastern Europe to over 600% increases amongst the South-East Asia, Southern & Central Asia, and Sub-Saharan Africa-born populations. CONCLUSIONS Cohort flow is the primary driver increasing the number of older migrants living with dementia. This growth is largely inevitable because the cohorts are already living in Australia as part of the migrant population, but currently at ages below 60 years. IMPLICATIONS FOR PUBLIC HEALTH High relative growth and shifting birthplace composition in the number of migrants living with dementia poses implications for culturally appropriate care, health care access and workforce needs to support migrant families, carers and their communities.
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Affiliation(s)
- Jeromey Temple
- Melbourne School of Population and Global Health, University of Melbourne, Victoria
| | - Tom Wilson
- Melbourne School of Population and Global Health, University of Melbourne, Victoria
| | | | - Kylie Radford
- Neuroscience Research Australia, University of New South Wales
| | - Dina LoGiudice
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria
| | - Ariane Utomo
- School of Geography, Earth and Atmospheric Sciences, University of Melbourne, Victoria
| | - Kaarin J Anstey
- Neuroscience Research Australia, University of New South Wales
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Le S, Zhang Y, Voutilainen A, Tan X, Laukkanen J, Wang C, Cheng S. Differences in cardiometabolic risk profiles between Chinese and Finnish older adults with glucose impairment and central obesity. J Endocrinol Invest 2022; 45:1427-1437. [PMID: 35325446 PMCID: PMC9184414 DOI: 10.1007/s40618-022-01777-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/23/2022] [Indexed: 12/06/2022]
Abstract
BACKGROUND Obesity and ethnicity play important roles in cardiovascular complications in patients with type 2 diabetes mellitus (T2DM). This study aimed to compare cardiometabolic risk profiles between Chinese and Finnish older adults of central obesity with prediabetes or T2DM. METHODS Study subjects were 60-74 years old and originated from two population samples. The Finnish subjects came from the Kuopio Ischemic Heart Disease (KIHD) study (n = 1089), and the Chinese subjects came from the Shanghai High-risk Diabetic Screen (SHiDS) study (n = 818). The KIHD and SHiDS studies used similar questionnaires to determine participants' baseline characteristics regarding the history of medication use and diseases and lifestyle factors. All study subjects participated in glucose tolerance tests and anthropometry assessments, including waist circumference measurements. RESULTS Among study subjects of central obesity with prediabetes (n = 298), fasting and 2-h glucose, and fasting insulin and insulin resistance were significantly higher in Chinese than in Finnish (p < 0.0001-0.016). In addition, triglyceride (TG) level was higher and the low-density lipoprotein cholesterol (LDL) and LDL to high-density lipoprotein cholesterol (HDL) ratio were lower in Chinese than in Finnish (p < 0.0001-0.003). Among subjects of central obesity with T2DM (n = 251), Chinese subjects had significantly less proportions of antihypertensive, glycaemic control medication, and statin users as well as lower level of physical activity (p < 0.0001 for all), while higher blood pressure (p = 0.002 for systolic blood pressure and p < 0.0001 for diastolic blood pressure), TG levels (p < 0.05) and HDL (p = 0.002) than the Finnish counterparts. There were no differences in β-cell function (HOMA-β) between Chinese and Finnish both in prediabetes and T2DM. CONCLUSIONS Our results indicated that Chinese and Finnish older adults of central obesity with prediabetes and T2DM had similar β-cell function. However, Chinese individuals with prediabetes are prone to insulin resistance. Meanwhile, lipid metabolism dysfunction is also different between Chinese and Finnish. Chinese older adults of central obesity with prediabetes showed higher TG, but Finnish showed higher LDL and LDL/HDL. Strategic for T2DM prevention and treatment should be ethnically specific.
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Affiliation(s)
- S Le
- Exercise Translational Medicine Center, Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, 200240, Shanghai, China
- Key Laboratory of Systems Biomedicine (Ministry of Education), Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai, 200240, China
- Department of Physical Therapy, Taihe Hospital, Hubei University of Medicine, Shiyan, 442099, China
- Faculty of Sport and Health Sciences, University of Jyväskylä, 40014, Jyväskylä, Finland
| | - Y Zhang
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, The Metabolic Disease Biobank, Shanghai, 200233, China
| | - A Voutilainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211, Kuopio, Finland
| | - X Tan
- Exercise Translational Medicine Center, Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, 200240, Shanghai, China
- Department of Neuroscience, Uppsala University, BMC, Box 593, 75124, Uppsala, Sweden
| | - J Laukkanen
- Faculty of Sport and Health Sciences, University of Jyväskylä, 40014, Jyväskylä, Finland.
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211, Kuopio, Finland.
- Institute of Clinical Medicine, Department of Medicine, University of Eastern Finland, 70211, Kuopio, Finland.
| | - C Wang
- Department of Endocrinology and Metabolism, School of Medicine, Shanghai Fourth People's Hospital Affiliated to Tongji University, Tongji University, 1279 Sanmen Road, Shanghai, 200434, China.
| | - S Cheng
- Exercise Translational Medicine Center, Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, 200240, Shanghai, China.
- Key Laboratory of Systems Biomedicine (Ministry of Education), Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai, 200240, China.
- Faculty of Sport and Health Sciences, University of Jyväskylä, 40014, Jyväskylä, Finland.
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The Morphology of Coronary Artery Disease in South Asians versus White Caucasians and its Implications. Can J Cardiol 2022; 38:1570-1579. [PMID: 35568268 DOI: 10.1016/j.cjca.2022.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 04/27/2022] [Accepted: 05/05/2022] [Indexed: 01/09/2023] Open
Abstract
South Asians (SAs) experience a higher prevalence and earlier onset of coronary artery disease and have worse outcomes relative to White Caucasians (WCs) following invasive revascularization procedures, a mainstay of coronary artery disease (CAD) management. We sought to review the differences in the CAD pattern and risk factors between SA and WC patients and discuss their potential impact on the development of coronary disease, acute coronary syndrome and revascularization outcomes. SAs have a more diffuse pattern with multi-vessel involvement compared to WCs. However, less is known about other morphological characteristics such as calcification of atherosclerotic plaque and coronary diameter in SA populations. Despite a similar coronary calcification burden, higher non-calcified plaque composition, elevated thrombosis and inflammatory markers likely contribute to the disease pattern. While the current evidence on the role of coronary vessel size remains inconsistent, smaller coronary diameters in SAs could play a potential role in the higher disease prevalence. This is especially important given the impact of coronary artery diameter on revascularization outcomes. In conclusion, SAs have a unique CAD risk profile comprised of traditional and novel risk factors. Our findings highlight the need for additional awareness of healthcare professionals of this specific risk profile and potential therapeutic targets, as well as the need for further research in this vulnerable population.
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Cho H, Jeoung S, Kang C, Jang S. Comparative analysis of cardio-cerebrovascular complications in immigrants and native-born Koreans with diabetes: Risk factors and perspectives. PLoS One 2022; 17:e0263046. [PMID: 35486634 PMCID: PMC9053795 DOI: 10.1371/journal.pone.0263046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/11/2022] [Indexed: 11/26/2022] Open
Abstract
Background Given the rapidly increasing number of immigrants, it is crucial to address health care issues involving immigrants to facilitate their safe and secure settlement. Especially for common chronic diseases, such as diabetes, immigrants face more complex obstacles to manage their chronic conditions than do native-born residents. Therefore, we aimed to assess differences in the incidence and associated risk factors of cardio-cerebrovascular (CCV) complications of immigrants compared with native-born Koreans with diabetes. Methods Immigrants and native-born Koreans who had new diagnosis of diabetes and simultaneously received anti-diabetic prescriptions in 2012 were defined by using Korean National Health Insurance Claim Database(KNHICD). CCV complications were assessed at a 3-year follow-up from the index date. We assessed differences in the CCV complications and risk factors using multiple cox regression models. Results In total, 4,008 patients (668 of immigrants and 3,340 of native-born Koreans) who had newly diagnosed diabetes and simultaneously received anti-diabetic prescriptions in 2012 were selected. Immigrants with diabetes were at a 1.39 times higher risk of having CCV complications than native-born Koreans with diabetes (95% CI: 1.021–1.881). Patients who had a usual sources of care (USC) presented a significantly reduced risk of cardio-cerebrovascular complication (HR: 0.452; 95% CI: 0.342–0.598) in both immigrants and native Koreans. In subgroup analysis in immigrants, patients having USC showed decreased risk of CCV incidence (HR: 0.35, 95% CI: 0.175–0.703), whereas >60 years old and Charlson comorbidity index (CCI) score >1 presented increased risk of CCV complications. Conclusion Immigrants with diabetes have a higher risk of CCV complications than native-born Koreans with diabetes. However, having a USC significantly decreased the risk of CCV complications. Therefore, the utilization of USC will benefit to reduce diabetic complications in immigrants as well as reduction of overall health care cost burden, it would be necessary to implement USC in diabetes care at the initial disease stage.
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Affiliation(s)
- Hyemin Cho
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Republic of Korea
- Health Insurance Research Institute, National Health Insurance Service, Wonju, Republic of Korea
| | - Sohyun Jeoung
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States of America
- Department of Medicine Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States of America
| | - Cinoo Kang
- Department of Biostatics and Epidemiology Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Sunmee Jang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Republic of Korea
- * E-mail:
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15
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Makowsky MJ, Davachi S, Jones CA. eHealth Literacy in a Sample of South Asian Adults in Edmonton, Alberta, Canada: Subanalysis of a 2014 Community-Based Survey. JMIR Form Res 2022; 6:e29955. [PMID: 35353044 PMCID: PMC9008520 DOI: 10.2196/29955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 01/13/2022] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Digital health interventions are efficient and flexible methods for enhancing the prevention and management of cardiovascular disease and type 2 diabetes. However, little is known about the characteristics associated with eHealth literacy in the Canadian South Asian population. OBJECTIVE The aim of this study is to describe perceived eHealth literacy and explore the extent to which it is associated with sociodemographic, health status, and technology use variables in a subset of South Asian Canadians. METHODS We analyzed data from the e-Patient Project survey, a mixed-mode cross-sectional survey that occurred in 2014. The eHealth Literacy Scale (eHEALS) was used to measure eHealth literacy in a convenience sample of 511 English- or Punjabi-speaking South Asian adults recruited from a community pharmacy, a family physician office, and community events in Edmonton, Alberta. Multivariable quantile regression was used to explore variables associated with eHealth literacy. RESULTS The analysis was restricted to 301 internet users (mean age 39.9, SD 14.8 years; 166/301, 55.1% female) who provided responses to all 8 eHEALS questions and complete demographic information. The mean overall eHEALS score was 29.3 (SD 6.8) out of 40, and 71.4% (215/301) agreed to at least 5 out of the 8 eHEALS items. The eHEALS item with the lowest level of agreement was "I can tell high-quality health resources from low-quality health resources on the internet" (182/301, 60.5%). Although there were statistically significant differences in eHEALS scores according to age, educational achievement, language preference, and the presence of chronic medical conditions, multivariable regression analysis indicated that language preference was the only variable independently associated with eHealth literacy (coefficient -6.0, 95% CI -9.61 to -2.39). CONCLUSIONS In our sample of South Asian Canadian internet users, preference for written health information in languages other than English was associated with lower eHealth literacy. Opportunities exist to improve eHealth literacy using culturally and linguistically tailored interventions.
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Affiliation(s)
- Mark J Makowsky
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Shahnaz Davachi
- Primary Health Care, Alberta Health Services, Calgary, AB, Canada
| | - Charlotte A Jones
- Faculty of Medicine, Southern Medical Program, University of British Columbia Okanagan Campus, Kelowna, BC, Canada
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Patel AP, Wang M, Kartoun U, Ng K, Khera AV. Quantifying and Understanding the Higher Risk of Atherosclerotic Cardiovascular Disease Among South Asian Individuals: Results From the UK Biobank Prospective Cohort Study. Circulation 2021; 144:410-422. [PMID: 34247495 DOI: 10.1161/circulationaha.120.052430] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Individuals of South Asian ancestry represent 23% of the global population, corresponding to 1.8 billion people, and have substantially higher risk of atherosclerotic cardiovascular disease compared with most other ethnicities. US practice guidelines now recognize South Asian ancestry as an important risk-enhancing factor. The magnitude of enhanced risk within the context of contemporary clinical care, the extent to which it is captured by existing risk estimators, and its potential mechanisms warrant additional study. METHODS Within the UK Biobank prospective cohort study, 8124 middle-aged participants of South Asian ancestry and 449 349 participants of European ancestry who were free of atherosclerotic cardiovascular disease at the time of enrollment were examined. The relationship of ancestry to risk of incident atherosclerotic cardiovascular disease-defined as myocardial infarction, coronary revascularization, or ischemic stroke-was assessed with Cox proportional hazards regression, along with examination of a broad range of clinical, anthropometric, and lifestyle mediators. RESULTS The mean age at study enrollment was 57 years, and 202 405 (44%) were male. Over a median follow-up of 11 years, 554 of 8124 (6.8%) individuals of South Asian ancestry experienced an atherosclerotic cardiovascular disease event compared with 19 756 of 449 349 (4.4%) individuals of European ancestry, corresponding to an adjusted hazard ratio of 2.03 (95% CI, 1.86-2.22; P<0.001). This higher relative risk was largely consistent across a range of age, sex, and clinical subgroups. Despite the >2-fold higher observed risk, the predicted 10-year risk of cardiovascular disease according to the American Heart Association/American College of Cardiology Pooled Cohort equations and QRISK3 equations was nearly identical for individuals of South Asian and European ancestry. Adjustment for a broad range of clinical, anthropometric, and lifestyle risk factors led to only modest attenuation of the observed hazard ratio to 1.45 (95% CI, 1.28-1.65, P<0.001). Assessment of variance explained by 18 candidate risk factors suggested greater importance of hypertension, diabetes, and central adiposity in South Asian individuals. CONCLUSIONS Within a large prospective study, South Asian individuals had substantially higher risk of atherosclerotic cardiovascular disease compared with individuals of European ancestry, and this risk was not captured by the Pooled Cohort Equations.
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Affiliation(s)
- Aniruddh P Patel
- Center for Genomic Medicine and Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston (A.P.P., A.V.K.).,Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA (A.P.P., M.W., A.V.K.).,Harvard Medical School, Boston, MA (A.P.P., A.V.K.)
| | - Minxian Wang
- Center for Genomic Medicine and Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston (A.P.P., A.V.K.).,Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA (A.P.P., M.W., A.V.K.)
| | - Uri Kartoun
- Center for Computational Health, IBM Research, Cambridge, MA (U.K., K.N.)
| | - Kenney Ng
- Center for Computational Health, IBM Research, Cambridge, MA (U.K., K.N.)
| | - Amit V Khera
- Center for Genomic Medicine and Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston (A.P.P., A.V.K.).,Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA (A.P.P., M.W., A.V.K.).,Harvard Medical School, Boston, MA (A.P.P., A.V.K.)
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Koirala B, Turkson-Ocran RA, Baptiste D, Koirala B, Francis L, Davidson P, Himmelfarb CD, Commodore-Mensah Y. Heterogeneity of Cardiovascular Disease Risk Factors Among Asian Immigrants: Insights From the 2010 to 2018 National Health Interview Survey. J Am Heart Assoc 2021; 10:e020408. [PMID: 34182790 PMCID: PMC8403310 DOI: 10.1161/jaha.120.020408] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background The Asian population is the fastest-growing immigrant population in the United States. Prior studies have examined the Asian immigrant population as a homogenous group. We hypothesized that there will be heterogeneity in cardiovascular disease risk factors among Asian immigrant subgroups (Indian subcontinent, Southeast Asia, Asia) compared with the non-Hispanic White population. Methods and Results A cross-sectional analysis of the 2010 to 2018 National Health Interview Survey was conducted among 508 941 adults who were born in Asian regions or were non-Hispanic White and born in the United States. Generalized linear models with Poisson distribution were fitted to compare the prevalence of self-reported hypertension, overweight/obesity, diabetes mellitus, high cholesterol, physical inactivity, and current smoking among Asian immigrants compared with White adults, adjusting for known confounders. We included 33 973 Asian immigrants from Southeast Asia (45%), Asia (29%), the Indian subcontinent (26%), and 474 968 White adults. Compared with non-Hispanic White adults, Indian subcontinent immigrants had the highest prevalence of overweight/obesity (prevalence ratio, 1.22; 95% CI, 1.19-1.25); Southeast Asian immigrants had the highest prevalence of high cholesterol (prevalence ratio, 1.16; 95% CI, 1.10-1.23); Indian subcontinent (prevalence ratio, 1.69; 95% CI, 1.49-1.93) and Southeast Asian (prevalence ratio, 1.38; 95% CI, 1.26-1.52) immigrants had a higher prevalence of diabetes. All Asian immigrant subgroups were more likely to be physically inactive and less likely to smoke than White adults. Conclusions We observed significant heterogeneity in cardiovascular disease risk factors among Asian immigrants and a varied prevalence of risk factors compared with non-Hispanic White adults. Providers caring for Asian immigrants should provide tailored and culturally informed care to improve the cardiovascular health of this diverse group.
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Affiliation(s)
| | | | | | | | | | | | - Cheryl Dennison Himmelfarb
- Johns Hopkins School of Nursing Baltimore MD.,Johns Hopkins School of Medicine Baltimore MD.,Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Yvonne Commodore-Mensah
- Johns Hopkins School of Nursing Baltimore MD.,Johns Hopkins Bloomberg School of Public Health Baltimore MD
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18
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Prasad GVR, Bhamidi V. Managing cardiovascular disease risk in South Asian kidney transplant recipients. World J Transplant 2021; 11:147-160. [PMID: 34164291 PMCID: PMC8218347 DOI: 10.5500/wjt.v11.i6.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/12/2021] [Accepted: 05/22/2021] [Indexed: 02/06/2023] Open
Abstract
South Asians (SA) are at higher cardiovascular risk than other ethnic groups, and SA kidney transplant recipients (SA KTR) are no exception. SA KTR experience increased major adverse cardiovascular events both early and late post-transplantation. Cardiovascular risk management should therefore begin well before transplantation. SA candidates may require aggressive screening for pre-transplant cardiovascular disease (CVD) due to their ethnicity and comorbidities. Recording SA ethnicity during the pre-transplant evaluation may enable programs to better assess cardiovascular risk, thus allowing for earlier targeted peri- and post-transplant intervention to improve cardiovascular outcomes. Diabetes remains the most prominent post-transplant cardiovascular risk factor in SA KTR. Diabetes also clusters with other metabolic syndrome components including lower high-density lipoprotein cholesterol, higher triglycerides, hypertension, and central obesity in this population. Dyslipidemia, metabolic syndrome, and obesity are all significant CVD risk factors in SA KTR, and contribute to increased insulin resistance. Novel biomarkers such as adiponectin, apolipoprotein B, and lipoprotein (a) may be especially important to study in SA KTR. Focused interventions to improve health behaviors involving diet and exercise may especially benefit SA KTR. However, there are few interventional clinical trials specific to the SA population, and none are specific to SA KTR. In all cases, understanding the nuances of managing SA KTR as a distinct post-transplant group, while still screening for and managing each CVD risk factor individually in all patients may help improve the long-term success of all kidney transplant programs catering to multi-ethnic populations.
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Affiliation(s)
- G V Ramesh Prasad
- Kidney Transplant Program, St. Michael's Hospital, Toronto M5C 2T2, ON, Canada
| | - Vaishnavi Bhamidi
- Kidney Transplant Program, St. Michael's Hospital, Toronto M5C 2T2, ON, Canada
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Kalra D, Vijayaraghavan K, Sikand G, Desai NR, Joshi PH, Mehta A, Karmally W, Vani A, Sitafalwalla SJ, Puri R, Duell PB, Brown A. Prevention of atherosclerotic cardiovascular disease in South Asians in the US: A clinical perspective from the National Lipid Association. J Clin Lipidol 2021; 15:402-422. [PMID: 33846108 DOI: 10.1016/j.jacl.2021.03.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/20/2021] [Indexed: 12/24/2022]
Abstract
It is now well recognized that South Asians living in the US (SAUS) have a higher prevalence of atherosclerotic cardiovascular disease (ASCVD) that begins earlier and is more aggressive than age-matched people of other ethnicities. SA ancestry is now recognized as a risk enhancer in the US cholesterol treatment guidelines. The pathophysiology of this is not fully understood but may relate to insulin resistance, genetic and dietary factors, lack of physical exercise, visceral adiposity and other, yet undiscovered biologic mechanisms. In this expert consensus document, we review the epidemiology of ASCVD in this population, enumerate the challenges faced in tackling this problem, provide strategies for early screening and education of the community and their healthcare providers, and offer practical prevention strategies and culturally-tailored dietary advice to lower the rates of ASCVD in this cohort.
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Affiliation(s)
- Dinesh Kalra
- Division of Cardiology, Rush University Medical Center, 1620W. Harrison St, Kellogg Suite 320, Chicago, IL 60612, United States.
| | | | - Geeta Sikand
- University of California Irvine School of Medicine, Irvine, CA, United States
| | - Nihar R Desai
- Yale School of Medicine, New Haven, CT, United States
| | - Parag H Joshi
- University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Anurag Mehta
- Emory University School of Medicine, Atlanta, GA, United States
| | - Wahida Karmally
- Columbia University Irving Medical Center, New York, NY, United States
| | - Anish Vani
- New York University Langone Health, New York, NY, United States
| | | | - Raman Puri
- Lipid Association of India, New Delhi, India
| | - P Barton Duell
- Oregon Health and Science University, Portland, OR, United States
| | - Alan Brown
- Advocate Lutheran General Hospital, Park Ridge, IL, United States
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Vyas MV, Austin PC, Fang J, Laupacis A, Silver FL, Kapral MK. Immigration Status, Ethnicity, and Long-term Outcomes Following Ischemic Stroke. Neurology 2021; 96:e1145-e1155. [PMID: 33472924 DOI: 10.1212/wnl.0000000000011451] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 09/30/2020] [Accepted: 10/28/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the association between immigration status and ethnicity and the outcomes of mortality and vascular event recurrence following ischemic stroke in Ontario, Canada. METHODS We conducted a retrospective cohort study using linked administrative and clinical registry-based data from 2002 to 2018 and compared hazards of all-cause mortality and vascular event recurrence in immigrants and long-term residents using inverse probability of treatment weighting accounting for age, sex, income, and comorbidities. We stratified analyses by age (≤75 and >75 years) and used interaction terms to evaluate whether the association between immigration status and outcomes varied with age or ethnicity. RESULTS We followed 31,918 adult patients, of whom 2,740 (8.6%) were immigrants, for a median follow-up of 5 years. Immigrants had lower mortality than long-term residents (46.1% vs 64.5%), which was attenuated after adjustment (hazard ratio [HR] 0.94; 95% confidence interval [CI] 0.88-1.00), but persisted in those younger than 75 years (HR 0.82; 0.74-0.91). Compared to their respective ethnic long-term resident counterparts, the adjusted hazard of death was higher in South Asian immigrants, similar in Chinese immigrants, and lower in other immigrants (p value for interaction = 0.003). The adjusted hazard of vascular event recurrence (HR 1.01; 0.92-1.11) was similar in immigrants and long-term residents, and this observation persisted across all age and ethnic groups. CONCLUSIONS Long-term mortality following ischemic stroke is lower in immigrants than in long-term residents, but is similar after adjustment for baseline characteristics, and it is modified by age at the time of stroke and by ethnicity.
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Affiliation(s)
- Manav V Vyas
- From the Divisions of Neurology (M.V.V., F.L.S.) and General Internal Medicine (A.L., M.K.K.), Department of Medicine, and Institute of Health Policy, Management and Evaluation (M.V.V., P.C.A., A.L., M.K.K.), University of Toronto; ICES (M.V.V., P.C.A., J.F., A.L., F.L.S., M.K.K.), Toronto, Canada; and Institute of Health Equity (M.V.V.), University College London, UK
| | - Peter C Austin
- From the Divisions of Neurology (M.V.V., F.L.S.) and General Internal Medicine (A.L., M.K.K.), Department of Medicine, and Institute of Health Policy, Management and Evaluation (M.V.V., P.C.A., A.L., M.K.K.), University of Toronto; ICES (M.V.V., P.C.A., J.F., A.L., F.L.S., M.K.K.), Toronto, Canada; and Institute of Health Equity (M.V.V.), University College London, UK
| | - Jiming Fang
- From the Divisions of Neurology (M.V.V., F.L.S.) and General Internal Medicine (A.L., M.K.K.), Department of Medicine, and Institute of Health Policy, Management and Evaluation (M.V.V., P.C.A., A.L., M.K.K.), University of Toronto; ICES (M.V.V., P.C.A., J.F., A.L., F.L.S., M.K.K.), Toronto, Canada; and Institute of Health Equity (M.V.V.), University College London, UK
| | - Andreas Laupacis
- From the Divisions of Neurology (M.V.V., F.L.S.) and General Internal Medicine (A.L., M.K.K.), Department of Medicine, and Institute of Health Policy, Management and Evaluation (M.V.V., P.C.A., A.L., M.K.K.), University of Toronto; ICES (M.V.V., P.C.A., J.F., A.L., F.L.S., M.K.K.), Toronto, Canada; and Institute of Health Equity (M.V.V.), University College London, UK
| | - Frank L Silver
- From the Divisions of Neurology (M.V.V., F.L.S.) and General Internal Medicine (A.L., M.K.K.), Department of Medicine, and Institute of Health Policy, Management and Evaluation (M.V.V., P.C.A., A.L., M.K.K.), University of Toronto; ICES (M.V.V., P.C.A., J.F., A.L., F.L.S., M.K.K.), Toronto, Canada; and Institute of Health Equity (M.V.V.), University College London, UK
| | - Moira K Kapral
- From the Divisions of Neurology (M.V.V., F.L.S.) and General Internal Medicine (A.L., M.K.K.), Department of Medicine, and Institute of Health Policy, Management and Evaluation (M.V.V., P.C.A., A.L., M.K.K.), University of Toronto; ICES (M.V.V., P.C.A., J.F., A.L., F.L.S., M.K.K.), Toronto, Canada; and Institute of Health Equity (M.V.V.), University College London, UK.
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Jaffer S, Foulds HJA, Parry M, Gonsalves CA, Pacheco C, Clavel MA, Mullen KA, Yip CYY, Mulvagh SL, Norris CM. The Canadian Women's Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women-Chapter 2: Scope of the Problem. CJC Open 2021; 3:1-11. [PMID: 33458627 PMCID: PMC7801195 DOI: 10.1016/j.cjco.2020.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 10/12/2020] [Indexed: 12/14/2022] Open
Abstract
Background This Atlas chapter summarizes the epidemiology of cardiovascular disease (CVD) in women in Canada, discusses sex and gender disparities, and examines the intersectionality between sex and other factors that play a prominent role in CVD outcomes in women, including gender, indigenous identity, ethnic variation, disability, and socioeconomic status. Methods CVD is the leading cause of premature death in Canadian women. Coronary artery disease, including myocardial infarction, and followed by stroke, accounts for the majority of CVD-related deaths in Canadian women. The majority of emergency department visits and hospitalizations by women are due to coronary artery disease, heart failure, and stroke. The effect of traditional cardiovascular risk factors and their association with increasing cardiovascular morbidity is unique in this group. Results Indigenous women in Canada experience increased CVD, linked to colonization and subsequent social, economic, and political challenges. Women from particular racial and ethnic backgrounds (ie, South Asian, Afro-Caribbean, Hispanic, and Chinese North American women) have greater CVD risk factors, and CVD risk in East Asian women increases with duration of stay in Canada. Conclusions Canadians living in northern, rural, remote, and on-reserve residences experience greater CVD morbidity, mortality, and risk factors. An increase in CVD risk among Canadian women has been linked with a background of lower socioeconomic status, and women with disabilities have an increased risk of adverse cardiac events.
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Affiliation(s)
- Shahin Jaffer
- Department of Medicine/Community Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Heather J A Foulds
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | | | - Christine Pacheco
- Pierre-Boucher Hospital, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - Marie-Annick Clavel
- Laval University, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Ville de Québec, Québec, Canada
| | - Kerri A Mullen
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Cindy Y Y Yip
- HeartLife Foundation of Canada, Toronto, Ontario, Canada
| | - Sharon L Mulvagh
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Colleen M Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.,Cardiovascular Health and Stroke Strategic Clinical Network, Alberta Health Services, Alberta, Canada
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Makowsky MJ, Jones CA, Davachi S. Prevalence and Predictors of Health-Related Internet and Digital Device Use in a Sample of South Asian Adults in Edmonton, Alberta, Canada: Results From a 2014 Community-Based Survey. JMIR Public Health Surveill 2021; 7:e20671. [PMID: 33416506 PMCID: PMC7822722 DOI: 10.2196/20671] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/20/2020] [Accepted: 10/29/2020] [Indexed: 12/16/2022] Open
Abstract
Background South Asian Canadians are at high risk of developing cardiovascular disease and diabetes. Consumer-oriented health information technology may help mitigate lifestyle risk factors and improve chronic disease self-management. Objective This study aims to explore the prevalence, patterns, and predictors of the use of the internet, digital devices, and apps for health purposes as well as preferences for future use of eHealth support in South Asian Canadians. Methods We conducted a cross-sectional, mixed-mode survey in a convenience sample of 831 South Asian adults recruited at faith-based gathering places, health care settings, and community events in Edmonton, Alberta, in 2014. The 706 responders (mean age 47.1, SD 17.6 years; n=356, 50.4% female; n=509, 72.1% Sikh) who provided complete sociodemographic information were included in the analysis, and the denominators varied based on the completeness of responses to each question. Multivariate logistic regression was used to determine sociodemographic and health status predictors of internet use, being a web-based health information seeker, smartphone or tablet ownership, health app use, and willingness to use various modes of eHealth support. Results Of all respondents, 74.6% (527/706) were internet users and 47.8% (336/703) were web-based health information seekers. In addition, 74.9% (527/704) of respondents owned a smartphone or tablet and 30.7% (159/518) of these had a health and fitness app. Most internet users (441/527, 83.7%) expressed interest in using ≥1 mode of eHealth support. Older age, being female, having less than high school education, preferring written health information in languages other than English, and lacking confidence in completing medical forms predicted lack of internet use. Among internet users, factors that predicted web-based health information seeking were being female, use of the internet several times per day, being confident in completing medical forms, and preferring health information in English. Predictors of not owning a smartphone or tablet were being older, preferring health information in languages other than English, having less than high school education, living in Canada for <5 years, having a chronic health condition, and having diabetes. Increasing age was associated with lower odds of having a health app. Preferring health information in languages other than English consistently predicted lower interest in all modes of eHealth support. Conclusions eHealth-based chronic disease prevention and management interventions are feasible for South Asian adults, but digital divides exist according to language preference, education, age, sex, confidence in completing medical forms, and number of years lived in Canada. Community-based, culturally tailored strategies targeting these factors are required to address existing divides and increase the uptake of credible web-based and app-based resources for health purposes.
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Affiliation(s)
- Mark J Makowsky
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Charlotte A Jones
- Faculty of Medicine, Southern Medical Program, University of British Columbia Okanagan Campus, Kelowna, BC, Canada
| | - Shahnaz Davachi
- Primary Health Care, Alberta Health Services, Calgary, AB, Canada
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Karmiris K. Racial Differences in Inflammatory Bowel Disease: A Race With Alternating Winners? Inflamm Bowel Dis 2020; 26:1878-1879. [PMID: 32144931 DOI: 10.1093/ibd/izaa022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Indexed: 12/16/2022]
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Huang L, Chen W, Renzaho AMN, Hall BJ. Validation of Obesity Status Based on Self-Reported Data among Filipina and Indonesian Female Migrant Domestic Workers in Macao (SAR), China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5927. [PMID: 32824130 PMCID: PMC7459685 DOI: 10.3390/ijerph17165927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/10/2020] [Accepted: 07/10/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Migrant domestic workers are at high risk of overweight and obesity. It is crucial to assess the prevalence of obesity among this migrant population, for surveillance and intervention. Self-reported height and weight are commonly used to derive body mass index (BMI) and assess the prevalence of obesity. The accuracy of BMI from self-reported height and weight in migrant populations remains unknown. The aim of this study was to assess the accuracy of BMI from self-reported measures and identify the optimal adjustment to be made to overweight and obesity cut-off points when using self-reported body mass index among migrant workers. METHODS Self-reported and objectively measured height and weight were obtained from 1388 female Filipina domestic workers and 369 female Indonesian domestic workers recruited using respondent-driven sampling between November 2016 and August 2017. Self-reported BMI (based on self-reported height and weight) and measured BMI (based on objectively measured height and weight) were calculated as weight in kilograms divided by the square of height in meters for all participants (kg/m2). RESULTS BMI derived from self-reported height and weight was underestimated for both Filipina (z = -27.5, p < 0.001) and Indonesian (z = -9.9, p < 0.001) participants. Applying the gold standard of Asian BMI cut-off points to self-reported BMI, the sensitivity in identifying overweight or obesity was 64.4% for Filipina participants and 78.6% for Indonesian participants and the specificity was 97.9% for Filipina participants and 93.8% for Indonesian participants for overweight or obesity. When self-reported measures were used, the receiver operator characteristic (ROC) curves and the corresponding area under the curve (AUC) indicated optimal cut-off points of 22.0 kg/m2 and 22.3 kg/m2 for Filipina and female Indonesian participants for overweight or obesity. CONCLUSIONS Although BMI derived from self-reported height and weight allows for quick and low-cost obesity screening, a considerable underestimation of overweight or obesity prevalence was observed in Filipina and female Indonesian migrant domestic workers in Macao (Special Administrative Region, SAR), China. With the best compromise between sensitivity and specificity, the new cut-off points can be used in future studies to identify overweight or obesity in these two populations using self-reported height and weight.
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Affiliation(s)
- Lei Huang
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong 999077, China;
- Global and Community Mental Health Research Group, Department of Psychology, Faculty of Social Sciences, University of Macau, Macau 999078, China
| | - Wen Chen
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510000, China;
- Sun Yat-sen Centre for Migrant Health Policy, Sun Yat-sen University, Guangzhou 510000, China
| | - Andre M. N. Renzaho
- School of Social Sciences and Translational Health Research Institute, Western Sydney University, Penrith 2750, Australia;
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne 3004, Australia
| | - Brian J. Hall
- Global and Community Mental Health Research Group, Department of Psychology, Faculty of Social Sciences, University of Macau, Macau 999078, China
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21201, USA
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Taleb I, Wever-Pinzon J, Wang W, Koliopoulou A, Dranow E, Yu T, Yin L, McKellar SH, Stehlik J, Fang JC, Wever-Pinzon O, Selzman CH, Drakos SG. Outcomes of Asian-Americans Implanted With Left Ventricular Assist Devices: An Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Analysis. Heart Lung Circ 2020; 29:1226-1233. [DOI: 10.1016/j.hlc.2019.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 09/20/2019] [Accepted: 11/17/2019] [Indexed: 01/18/2023]
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Gupta MD, Gupta P, Mp G, Roy A, Qamar A. Risk factors for myocardial infarction in very young South Asians. Curr Opin Endocrinol Diabetes Obes 2020; 27:87-94. [PMID: 32073427 DOI: 10.1097/med.0000000000000532] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW It is only over the last few decades that the impact of coronary artery disease (CAD) in very young South Asian population has been recognized. There has been a tremendous interest in elucidating the causes behind this phenomenon and these efforts have uncovered several mechanisms that might explain the early onset of CAD in this population. The complete risk profile of very young South Asians being affected by premature CAD still remains unknown. RECENT FINDINGS The existing data fail to completely explain the burden of premature occurrence of CAD in South Asians especially in very young individuals. Results from some studies identified nine risk factors, including low consumption of fruits and vegetables, smoking, alcohol, diabetes, psychosocial factors, sedentary lifestyle, abdominal obesity, hypertension and dyslipidemia as the cause of myocardial infarction in 90% of the patients in this population. Recent large genome-wide association studies have discovered the association of several novel genetic loci with CAD in South Asians. Nonetheless, continued scientific efforts are required to further our understanding of the causal risk factors of CAD in South Asians to address the rising burden of CVD in this vulnerable population. SUMMARY In this review, we discuss established and emerging risk factors of CAD in this population.
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Affiliation(s)
- Mohit D Gupta
- Department of Cardiology, Gobind Ballabh Pant Institute of Postgraduate Medical Education and Research
| | - Puneet Gupta
- Department of Cardiology, Janakpuri Superspeciality Hospital
| | - Girish Mp
- Department of Cardiology, Gobind Ballabh Pant Institute of Postgraduate Medical Education and Research
| | - Ambuj Roy
- Department of Cardiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Arman Qamar
- Cardiovascular Division, New York University School of Medicine, New York, New York, USA
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Al-Sofiani ME, Langan S, Kanaya AM, Kandula NR, Needham BL, Kim C, Vaidya D, Golden SH, Gudzune KA, Lee CJ. The relationship of acculturation to cardiovascular disease risk factors among U.S. South Asians: Findings from the MASALA study. Diabetes Res Clin Pract 2020; 161:108052. [PMID: 32113027 PMCID: PMC7445080 DOI: 10.1016/j.diabres.2020.108052] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 01/23/2020] [Accepted: 01/31/2020] [Indexed: 12/22/2022]
Abstract
AIM We investigated the association between acculturation strategies and cardiometabolic risk among South Asian (SA) immigrants in the US. METHODS In this cross-sectional analysis of data from 849 SA participants in the Mediators of Atherosclerosis in SAs Living in America (MASALA), we performed multidimensional measures of acculturation to categorize the participants into three acculturation classes: separation (preference for SA culture), assimilation (preference for US culture), and integration (similar preference for both cultures). Differences in glycemic indices, blood pressure, lipid parameters and body composition by acculturation strategy were examined. RESULTS Women in the integration class had the lowest prevalence of diabetes (16.4%), prediabetes (29.7%), fasting and 2-h glucose compared to women in the separation class with the highest prevalence of diabetes (29.3%), prediabetes (31.5%), fasting and 2-h glucose and 2-hr insulin (all p < 0.05). Women in the assimilation class had significantly lower triglycerides, BMI, and waist circumference and higher HDL compared to women in the separation class after adjusting for age, study site, and years in the US. After additionally accounting for socioeconomic/lifestyle factors, women in the assimilation class had significantly lower triglyceride and higher HDL levels compared to women in the separation class (p < 0.01). There was no significant association between acculturation strategies and cardiometabolic risk in SA men. CONCLUSION SA women who employed an assimilation or integration strategy had a more favorable cardiometabolic profile compared to women using a separation strategy. Future research should investigate the behavioral and psychosocial pathways linking acculturation strategies with cardiometabolic health to inform preventive interventions among SAs living in America.
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Affiliation(s)
- Mohammed E Al-Sofiani
- Division of Endocrinology, Diabetes & Metabolism, King Saud University, Riyadh, Saudi Arabia; Division of Endocrinology, College of Medicine, The Johns Hopkins University, Baltimore, MD, United States; Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Susan Langan
- Division of Endocrinology, College of Medicine, The Johns Hopkins University, Baltimore, MD, United States
| | - Alka M Kanaya
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Namratha R Kandula
- Feinberg School of Medicine, Division of General Internal Medicine, Northwestern University, Chicago, IL, United States
| | - Belinda L Needham
- Department of Epidemiology and Center for Social Epidemiology and Population Health, University of Michigan, Ann Arbor, MI, United States
| | - Catherine Kim
- Departments of Medicine, Obstetrics & Gynecology, and Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | - Dhananjay Vaidya
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Sherita H Golden
- Division of Endocrinology, College of Medicine, The Johns Hopkins University, Baltimore, MD, United States; The Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University, Baltimore, MD, United States
| | - Kimberly A Gudzune
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, United States; The Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University, Baltimore, MD, United States
| | - Clare J Lee
- Division of Endocrinology, College of Medicine, The Johns Hopkins University, Baltimore, MD, United States.
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Pradhananga S, Regmi K, Razzaq N, Ettefaghian A, Dey AB, Hewson D. Ethnic differences in the prevalence of frailty in the United Kingdom assessed using the electronic Frailty Index. Aging Med (Milton) 2019; 2:168-173. [PMID: 31942531 PMCID: PMC6880682 DOI: 10.1002/agm2.12083] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/05/2019] [Accepted: 08/02/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE There have been few studies in which the prevalence of frailty of different ethnic groups has been assessed in multiethnic countries. The aim of this study was to evaluate the prevalence of frailty in different ethnic groups in the United Kingdom. METHODS Anonymized electronic health records (EHR) of 13 510 people aged 65 years and over were extracted from the database of a network of general practitioners, covering 16 clinical commissioning groups in London. Frailty was determined using the electronic Frailty Index (eFI), which was automatically calculated using EHR data. The eFI was used as a categorical variable with fit and mild frailty grouped together, and moderate and severe frailty grouped as frail. RESULTS The overall prevalence of frailty was 18.1% (95% confidence interval [CI], 17.4%-18.9%). The prevalence of frailty increased with age (odds ratio [OR], 1.11; 95% CI, 1.10-1.12) and body mass index (BMI; OR, 1.05; 95% CI, 1.04-1.06). The highest prevalence of frailty was observed for Bangladeshis, with 32.9% classified as frail (95% CI, 29.2-36.7); and the lowest prevalence of 14.0% (95% CI, 12.6-15.5) was observed for the Black ethnic group. Stepwise logistic regression retained ethnicity, age, and BMI as predictors of frailty. CONCLUSION This pilot study identified differences in the prevalence of frailty between ethnic groups in a sample of older people living in London. Additional studies are warranted to determine the causes of such differences, including migration and socioeconomic status. It would be worthwhile carrying out a validation study of the eFI in different ethnic populations.
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Affiliation(s)
| | - Krishna Regmi
- Institute for Health ResearchUniversity of BedfordshireLutonUK
| | - Nasrin Razzaq
- Business Intelligence DepartmentAT Medics LtdLondonUK
| | | | - Aparajit Ballav Dey
- Department of Geriatric MedicineAll India Institute of Medical SciencesNew DelhiIndia
| | - David Hewson
- Institute for Health ResearchUniversity of BedfordshireLutonUK
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Prabhakaran D, Singh K, Roth GA, Banerjee A, Pagidipati NJ, Huffman MD. Cardiovascular Diseases in India Compared With the United States. J Am Coll Cardiol 2019; 72:79-95. [PMID: 29957235 DOI: 10.1016/j.jacc.2018.04.042] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/11/2018] [Accepted: 04/25/2018] [Indexed: 01/01/2023]
Abstract
This review describes trends in the burden of cardiovascular diseases (CVDs) and risk factors in India compared with the United States; provides potential explanations for these differences; and describes strategies to improve cardiovascular health behaviors, systems, and policies in India. The prevalence of CVD in India has risen over the past 2 decades due to population growth, aging, and a stable age-adjusted CVD mortality rate. Over the same time period, the United States has experienced an overall decline in age-adjusted CVD mortality, although the trend has begun to plateau. These improvements in CVD mortality in the United States are largely due to favorable population-level risk factor trends, specifically with regard to tobacco use, cholesterol, and blood pressure, although improvements in secondary prevention and acute care have also contributed. To realize similar gains in reducing premature death and disability from CVD, India needs to implement population-level policies while strengthening and integrating its local, regional, and national health systems. Achieving universal health coverage that includes financial risk protection should remain a goal to help all Indians realize their right to health.
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Affiliation(s)
- Dorairaj Prabhakaran
- Public Health Foundation of India and Centre for Chronic Disease Control, Gurgaon, India; London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Kavita Singh
- Public Health Foundation of India and Centre for Chronic Disease Control, Gurgaon, India
| | - Gregory A Roth
- Institute for Health Metrics and Evaluation and the Division of Cardiology at the University of Washington School of Medicine, Seattle, Washington
| | - Amitava Banerjee
- Farr Institute of Health Informatics, University College London, London, United Kingdom
| | - Neha J Pagidipati
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Mark D Huffman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Tatara N, Hammer HL, Mirkovic J, Kjøllesdal MKR, Andreassen HK. Associations Between Immigration-Related User Factors and eHealth Activities for Self-Care: Case of First-Generation Immigrants From Pakistan in the Oslo Area, Norway. JMIR Public Health Surveill 2019; 5:e11998. [PMID: 31420957 PMCID: PMC6716338 DOI: 10.2196/11998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 07/11/2019] [Accepted: 07/28/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Immigrant populations are often disproportionally affected by chronic diseases, such as type 2 diabetes mellitus (T2DM). Use of information and communication technology (ICT) is one promising approach for better self-care of T2DM to mitigate the social health inequalities, if designed for a wider population. However, knowledge is scarce about immigrant populations' diverse electronic health (eHealth) activities for self-care, especially in European countries. OBJECTIVE With a target group of first-generation immigrants from Pakistan in the Oslo area, Norway, we aimed to understand their diverse eHealth activities for T2DM self-care in relation to immigration-related user factors specific to this target group: proficiency in relevant languages (Urdu, Norwegian, English), length of residence in Norway, and diagnosis of T2DM compared with general user factors (age, gender, education and digital skills, and self-rated health status). METHODS Data were from a survey among the target population (N=176) conducted in 2015-2016. Using logistic regression, we analyzed associations between user factors and experiences of each of the following eHealth activities for T2DM self-care in the last 12 months: first, information seeking by (1) search engines and (2) Web portals or email subscriptions; second, communication and consultation (1) by closed conversation with a few acquaintances using ICT and (2) on social network services; and third, active decision making by using apps for (1) tracking health information and (2) self-assessment of health status. Using Poisson regression, we also assessed the relationship between user factors and variety of eHealth activities experienced. The Bonferroni correction was used to address the multiple testing problem. RESULTS Regression analyses yielded the following significantly positive associations: between Urdu literacy and (1) information seeking by Web portals or email subscriptions (odds ratio [OR] 2.155, 95% CI 1.388-3.344), (2) communication and consultation on social network services (OR 5.697, 95% CI 2.487-13.053), and (3) variety (estimate=0.350, 95% CI 0.148-0.552); between length of residence in Norway and (1) communication and consultation by closed conversation with a few acquaintances using ICT (OR 1.728, 95% CI 1.193-2.503), (2) communication and consultation on social network services (OR 2.098, 95% CI 1.265-3.480), and (3) variety (estimate=0.270, 95% CI 0.117-0.424); between Norwegian language proficiency and active decision making by using apps for self-assessment of health status (OR 2.285, 95% CI 1.294-4.036); between education and digital skills and active decision making by using apps for tracking health information (OR 3.930, 95% CI 1.627-9.492); and between being a female and communication and consultation by closed conversation with a few acquaintances using ICT (OR 2.883, 95% CI 1.335-6.227). CONCLUSIONS This study implies immigration-related factors may confound associations between general user factors and eHealth activities. Further studies are needed to explore the influence of immigration-related user factors for eHealth activities in other immigrant groups and countries. INTERNATIONAL REGISTERED REPORT RR2-DOI 10.2196/resprot.5468.
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Affiliation(s)
- Naoe Tatara
- Department of Computer Science, Faculty of Technology, Art and Design, Oslo Metropolitan University, Oslo, Norway
| | - Hugo Lewi Hammer
- Department of Computer Science, Faculty of Technology, Art and Design, Oslo Metropolitan University, Oslo, Norway
| | - Jelena Mirkovic
- Center for Shared Decision Making and Collaborative Care Research, Oslo University Hospital, Oslo, Norway
| | - Marte Karoline Råberg Kjøllesdal
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.,Health Services Research, Norwegian Institute of Public Health, Oslo, Norway
| | - Hege Kristin Andreassen
- Centre for Women's and Gender Research, UiT The Arctic University of Norway, Tromsø, Norway.,Centre for Care Research, Norwegian University of Science and Technology, Gjøvik, Norway
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Wang J, Tillin T, Hughes AD, Chaturvedi N. Associations between family history and coronary artery calcium and coronary heart disease in British Europeans and South Asians. Int J Cardiol 2019; 300:39-42. [PMID: 31400886 PMCID: PMC6970219 DOI: 10.1016/j.ijcard.2019.07.101] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/27/2019] [Accepted: 07/31/2019] [Indexed: 11/08/2022]
Abstract
Background The role of family history in determining excess risk of coronary heart disease (CHD) in South Asians compared with Europeans is unclear. We hypothesized that family history would be more strongly associated with CHD in South Asians. Methods We performed cross-sectional analyses of 20-year follow-up data from SABRE (Southall And Brent Revisited) population-based study. Initial recruitment (1988–1991) was by random selection from general practitioners' lists in north-west London. 974 Europeans and 734 South Asians completed follow-up questionnaire (2008–2011) and had complete CHD and family history data. 831 participants without cardiovascular disease had complete coronary artery calcium (CAC) data. Results South Asians with family history of CHD were more likely to have diagnosed CHD (odds ratio 1.71 [95% CI 1.21, 2.42]; p = 0.002) and more previous CHD events (regression coefficient 0.44 [0.16, 0.72]; p = 0.002) than those without family history, independent of biological and sociodemographic risk factors. Family history associations with diagnosed CHD/number of events were weaker in Europeans (odds ratio 1.11 [0.78, 1.57]; p = 0.562/regression coefficient 0.02 [−0.25, 0.30]; p = 0.878), largely explained by biological risk factors. South Asians with family history had modestly increased CAC burden compared with Europeans. Conclusions There were markedly stronger associations between family history and clinical CHD in South Asians, and a similar trend for subclinical CHD. Early preventive and therapeutic interventions are particularly important in South Asians with a family history of CHD. Family history of CHD is greatly associated with clinical CHD in South Asians. The associations are stronger in British South Asians than Europeans. There is a similar trend for subclinical CHD. The associations in South Asians are unexplained by conventional risk factors.
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Affiliation(s)
- Jingyi Wang
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, Floor 5, 1 - 19 Torrington Place, London WC1E 7HB, United Kingdom.
| | - Therese Tillin
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, Floor 5, 1 - 19 Torrington Place, London WC1E 7HB, United Kingdom.
| | - Alun D Hughes
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, Floor 5, 1 - 19 Torrington Place, London WC1E 7HB, United Kingdom.
| | - Nish Chaturvedi
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, Floor 5, 1 - 19 Torrington Place, London WC1E 7HB, United Kingdom.
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Chhungi V, Ningombam SS, Yadav S, Singh HS, Devi NK, Chandel S, Mondal PR, Sachdeva MP, Saraswathy KN. Prevalence of cardiovascular risk factors among tribal and non-tribal populations with East Asian Ancestry from North East India. Am J Hum Biol 2019; 31:e23263. [PMID: 31197927 DOI: 10.1002/ajhb.23263] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 04/20/2019] [Accepted: 05/16/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES The distribution of hypertension, type 2 diabetes, dyslipidemia, and obesity variables were studied among tribal and non-tribal populations with East Asian ancestry from northeast India. METHODS Data pertaining to somatometric measurements, blood pressure, lipid profile, and fasting blood glucose were collected from 1916 participants (Mizo-422, Liangmai-352, and Meitei-1142) of both sexes older than 18 years. Two-way ANOVA and chi square analysis were done to understand the inter-population prevalence differences. RESULTS Differential distribution of obesity variables, hypertension, type 2 diabetes, and dyslipidemia was observed among the three populations. CONCLUSIONS Population-specific prevalence studies need to be conducted to develop population-specific health strategies, specifically in countries like India with huge diversity.
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Affiliation(s)
- Varhlun Chhungi
- Laboratory of Biochemical and Molecular Anthropology, Department of Anthropology, University of Delhi, New Delhi, India
| | - Somorjit Singh Ningombam
- Laboratory of Biochemical and Molecular Anthropology, Department of Anthropology, University of Delhi, New Delhi, India
| | - Suniti Yadav
- Laboratory of Biochemical and Molecular Anthropology, Department of Anthropology, University of Delhi, New Delhi, India
| | | | - Naorem Kiranmala Devi
- Laboratory of Biochemical and Molecular Anthropology, Department of Anthropology, University of Delhi, New Delhi, India
| | - Shivani Chandel
- Laboratory of Biochemical and Molecular Anthropology, Department of Anthropology, University of Delhi, New Delhi, India
| | - Prakash Ranjan Mondal
- Laboratory of Biochemical and Molecular Anthropology, Department of Anthropology, University of Delhi, New Delhi, India
| | - Mohinder Pal Sachdeva
- Laboratory of Biochemical and Molecular Anthropology, Department of Anthropology, University of Delhi, New Delhi, India
| | - Kallur Nava Saraswathy
- Laboratory of Biochemical and Molecular Anthropology, Department of Anthropology, University of Delhi, New Delhi, India
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Patel M, Boutin-Foster C, Phillips E. Understanding of cardiovascular disease risk factors among Bangladeshi immigrants in New York City. ETHNICITY & HEALTH 2019; 24:432-442. [PMID: 28669239 DOI: 10.1080/13557858.2017.1346191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 05/17/2017] [Indexed: 05/25/2023]
Abstract
OBJECTIVES Among all South Asians, Bangladeshis have the highest prevalence of cardiovascular disease (CVD). The purpose of our study was to compare the understanding of CVD risk factors among Bangladeshi immigrants to the general Caucasian population in the U.S. DESIGN We surveyed Bangladeshi immigrants in Queens, New York using a CVD risk factor knowledge instrument used in the Coronary Artery Risk Development in Young Adults (CARDIA) study to assess awareness of risk factors. Using multivariate regression modeling, we compared scores on the knowledge instrument between Bangladeshis we surveyed and Caucasians from the CARDIA study, controlling for potential confounders. We subsequently examined the frequency of mentioning each risk factor to understand what was driving the difference in the overall score. RESULTS The proportion of Bangladeshis scoring low on the knowledge assessment was 0.53, where as the proportion of whites scoring low in the CARDIA study was 0.32 (p value < .001). Whites were 34% more likely to score high than Bangladeshis (adjusted odds ratio [aOR] 1.34, 95% confidence interval [CI] 1.19-1.52). Bangladeshis were more likely to mention diet and cholesterol as risk factors and less likely to mention lack of exercise, being overweight, and smoking as risk factors. CONCLUSION Understanding of cardiovascular disease risk factors was lower among Bangladeshis than whites. This was driven by Bangladeshis having less awareness regarding how exercise and being overweight contribute to CVD. Community based interventions and community health partnerships should target these behavioral risk factors in the Bangladeshi population.
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Affiliation(s)
- Mihir Patel
- a Division of General Internal Medicine, Department of Medicine , George Washington University , Washington , DC , USA
| | - Carla Boutin-Foster
- b Office of Diversity Education & Research , SUNY Downstate Medical Center , Brooklyn , NY , USA
| | - Erica Phillips
- c Division of General Internal Medicine , Weill Cornell Medicine , New York , NY , USA
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Moorthy V, Sim MA, Liu W, Ti LK, Chew STH. Association Between Ethnicity and Postoperative Hyperglycemia in a Southeast Asian Population Undergoing Cardiac Surgery. J Cardiothorac Vasc Anesth 2019; 33:388-393. [DOI: 10.1053/j.jvca.2018.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Indexed: 01/16/2023]
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Perini W, Kunst AE, Snijder MB, Peters RJG, van Valkengoed IGM. Ethnic differences in metabolic cardiovascular risk among normal weight individuals: Implications for cardiovascular risk screening. The HELIUS study. Nutr Metab Cardiovasc Dis 2019; 29:15-22. [PMID: 30467070 DOI: 10.1016/j.numecd.2018.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/31/2018] [Accepted: 09/17/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Cardiovascular disease (CVD) risk factors may occur among a substantial proportion of normal weight individuals, particularly among some ethnic minorities. It is unknown how many of these individuals would be missed by commonly applied eligibility criteria for cardiovascular risk screening. Thus, we aim to determine cardiovascular risk and eligibility for cardiovascular risk screening among normal weight individuals of different ethnic backgrounds. METHODS AND RESULTS Using the HELIUS study (Amsterdam, The Netherlands), we determined cardiovascular risk among 6910 normal weight individuals of Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Moroccan and Turkish background. High cardiovascular risk was approximated by high metabolic risk based on blood pressure, HDL, triglycerides and fasting glucose. Eligibility criteria for screening were derived from Dutch CVD prevention guidelines and include age ≥ 50 y, family history of CVD, or current smoking. Ethnic group comparisons were made using logistic regression. Age-adjusted proportions of high metabolic risk ranged from 12.6% to 38.4% (men) and from 2.7% to 11.5% (women). This prevalence was higher among most ethnic minorities than the Dutch, especially among women. For most ethnic groups, 79.9%-86.7% of individuals with high metabolic risk were eligible for cardiovascular risk screening. Exceptions were Ghanaian women (58.8%), Moroccan men (70.9%) and Moroccan women (45.0%), although age-adjusted proportions did not differ between groups. CONCLUSION Even among normal weight individuals, high cardiovascular metabolic risk is more common among ethnic minorities than among the majority population. Regardless of ethnicity, most normal weight individuals with increased risk are eligible for cardiovascular risk screening.
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Affiliation(s)
- W Perini
- Department of Public Health, Amsterdam UMC, University of Amsterdam, the Netherlands; Department of Cardiology, Amsterdam UMC, University of Amsterdam, the Netherlands.
| | - A E Kunst
- Department of Public Health, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - M B Snijder
- Department of Public Health, Amsterdam UMC, University of Amsterdam, the Netherlands; Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - R J G Peters
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - I G M van Valkengoed
- Department of Public Health, Amsterdam UMC, University of Amsterdam, the Netherlands
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Tharmaratnam T, Iskandar MA, Doherty S, D'Urzo KA, Kopalakrishnan S, Tabobondung TC, Gopee-Ramanan P, Sivagurunathan S, Sivananthan N. The Role of Physical Activity Prescription in Cardiovascular Disease Prevention Amongst South Asian Canadians. Front Cardiovasc Med 2018; 5:165. [PMID: 30488037 PMCID: PMC6246639 DOI: 10.3389/fcvm.2018.00165] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 10/26/2018] [Indexed: 01/07/2023] Open
Abstract
Unequivocal evidence suggests an increased prevalence of cardiovascular disease (CVD) amongst South Asian Canadians (SACs) compared to other ethnic cohorts, due to a combination of their unique cardiometabolic profile and environmental factors. This unfavorable CVD profile is characterized by an elevated risk of dyslipidemia, high apolipoprotein B/apolipoprotein A1 ratio, hypertension, glucose intolerance, type 2 diabetes mellitus, as well as increased BMI, body fat percentage, abdominal and visceral adiposity. Despite the overwhelming evidence for the effectiveness of physical activity (PA) in circumventing the onset of CVD and in the reduction of CVD risk factors, SACs are among the most physically inactive cohorts in Canada. This relates to a set of common and unique socio-cultural barriers, such as gender, beliefs and perceptions about illness, immigration, unfavorable PA environments, and their high prevalence of debilitating chronic diseases. Several strategies to improve PA participation rates in this high-risk population have been suggested, and include the implementation of culturally sensitive PA interventions, as well as clinician training in PA prescription through workshops that emphasize knowledge translation into clinical practice. Therefore, the purpose of this mini-review is to highlight and discuss: (1) the burden of heart disease in SACs (2) the cardiovascular benefits of PA for SACs; (3) factors affecting PA participation among SACs and how they can be addressed; (4) the impact of culturally sensitive PA prescription on CVD prevention; (5) barriers to culture-specific PA prescription by clinicians, and strategies to improve its use and impact.
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Affiliation(s)
| | - Mina A. Iskandar
- School of Medicine, Royal College of Surgeons in Ireland, Adliya, Bahrain
| | - Sally Doherty
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- School of Medicine, Royal College of Surgeons in Ireland, Adliya, Bahrain
| | - Katrina A. D'Urzo
- School of Kinesiology and Health Studies, Queens University, Kingston, ON, Canada
| | | | - Tyler Cameron Tabobondung
- Department of Family Medicine, Michael G. DeGroote School of Medicine, Brantford General Hospital, McMaster University, Hamilton, ON, Canada
| | - Prasaanthan Gopee-Ramanan
- Department of Diagnostic Radiology, Hamilton Health Sciences Centre, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Seyon Sivagurunathan
- Department of Family Medicine, Stonechurch Family Health Clinic, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Nirunthan Sivananthan
- Department of Pharmacology & Toxicology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Wisnieski L, Kerver J, Holzman C, Todem D, Margerison-Zilko C. Breastfeeding and Risk of Metabolic Syndrome in Children and Adolescents: A Systematic Review. J Hum Lact 2018; 34:515-525. [PMID: 29100483 DOI: 10.1177/0890334417737038] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The beneficial effect of breastfeeding on individual components of the metabolic syndrome in children and adolescents has been reported, but it is unknown if there is an association between being breastfed and metabolic syndrome as a whole. Research aim: This systematic review was performed to assess quality and strength of evidence for the association between being breastfed and the development of metabolic syndrome in children and adolescents. METHODS Articles were obtained from searches using PubMed and Embase databases, as well as from secondary searches through reference lists. Study quality was assessed using a three-level quality rating system. RESULTS Of 11 studies reviewed, 7 found a protective association between breastfeeding and metabolic syndrome and 4 found no association. There was no clear dose-response relationship between duration of breastfeeding and metabolic syndrome risk and insufficient evidence to demonstrate an added effect of being exclusively breastfed. The overall quality of the articles was moderate. In general, lower quality articles found no significant association, whereas higher quality articles found a significant association. CONCLUSION Our review demonstrated a limited amount of high-quality research on the relationship between being breastfed and development of metabolic syndrome in children and adolescents. The evidence presented in this review suggests that being breastfed may be protective against metabolic syndrome, but further research with improvements in study design, such as improved measurement of breastfeeding and the use of prospectively collected data, will improve our understanding of this relationship.
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Affiliation(s)
- Lauren Wisnieski
- 1 Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Jean Kerver
- 1 Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Claudia Holzman
- 1 Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - David Todem
- 1 Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Claire Margerison-Zilko
- 1 Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
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Geldsetzer P, Manne-Goehler J, Theilmann M, Davies JI, Awasthi A, Danaei G, Gaziano TA, Vollmer S, Jaacks LM, Bärnighausen T, Atun R. Geographic and sociodemographic variation of cardiovascular disease risk in India: A cross-sectional study of 797,540 adults. PLoS Med 2018; 15:e1002581. [PMID: 29920517 PMCID: PMC6007838 DOI: 10.1371/journal.pmed.1002581] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 05/09/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of mortality in India. Yet, evidence on the CVD risk of India's population is limited. To inform health system planning and effective targeting of interventions, this study aimed to determine how CVD risk-and the factors that determine risk-varies among states in India, by rural-urban location, and by individual-level sociodemographic characteristics. METHODS AND FINDINGS We used 2 large household surveys carried out between 2012 and 2014, which included a sample of 797,540 adults aged 30 to 74 years across India. The main outcome variable was the predicted 10-year risk of a CVD event as calculated with the Framingham risk score. The Harvard-NHANES, Globorisk, and WHO-ISH scores were used in secondary analyses. CVD risk and the prevalence of CVD risk factors were examined by state, rural-urban residence, age, sex, household wealth, and education. Mean CVD risk varied from 13.2% (95% CI: 12.7%-13.6%) in Jharkhand to 19.5% (95% CI: 19.1%-19.9%) in Kerala. CVD risk tended to be highest in North, Northeast, and South India. District-level wealth quintile (based on median household wealth in a district) and urbanization were both positively associated with CVD risk. Similarly, household wealth quintile and living in an urban area were positively associated with CVD risk among both sexes, but the associations were stronger among women than men. Smoking was more prevalent in poorer household wealth quintiles and in rural areas, whereas body mass index, high blood glucose, and systolic blood pressure were positively associated with household wealth and urban location. Men had a substantially higher (age-standardized) smoking prevalence (26.2% [95% CI: 25.7%-26.7%] versus 1.8% [95% CI: 1.7%-1.9%]) and mean systolic blood pressure (126.9 mm Hg [95% CI: 126.7-127.1] versus 124.3 mm Hg [95% CI: 124.1-124.5]) than women. Important limitations of this analysis are the high proportion of missing values (27.1%) in the main outcome variable, assessment of diabetes through a 1-time capillary blood glucose measurement, and the inability to exclude participants with a current or previous CVD event. CONCLUSIONS This study identified substantial variation in CVD risk among states and sociodemographic groups in India-findings that can facilitate effective targeting of CVD programs to those most at risk and most in need. While the CVD risk scores used have not been validated in South Asian populations, the patterns of variation in CVD risk among the Indian population were similar across all 4 risk scoring systems.
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Affiliation(s)
- Pascal Geldsetzer
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Jennifer Manne-Goehler
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America.,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Michaela Theilmann
- Department of Economics, University of Goettingen, Göttingen, Germany.,Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
| | - Justine I Davies
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Centre for Global Health, King's College London, London, United Kingdom
| | - Ashish Awasthi
- Indian Institute of Public Health, Gandhinagar, Gujarat, India.,Public Health Foundation of India, Delhi, National Capital Region, India
| | - Goodarz Danaei
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Thomas A Gaziano
- Department of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.,Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Sebastian Vollmer
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America.,Department of Economics, University of Goettingen, Göttingen, Germany.,Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
| | - Lindsay M Jaacks
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America.,Public Health Foundation of India, Delhi, National Capital Region, India
| | - Till Bärnighausen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America.,Institute of Public Health, Heidelberg University, Heidelberg, Germany.,Africa Health Research Institute, Mtubatuba, South Africa
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America.,Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts, United States of America
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Volgman AS, Palaniappan LS, Aggarwal NT, Gupta M, Khandelwal A, Krishnan AV, Lichtman JH, Mehta LS, Patel HN, Shah KS, Shah SH, Watson KE. Atherosclerotic Cardiovascular Disease in South Asians in the United States: Epidemiology, Risk Factors, and Treatments: A Scientific Statement From the American Heart Association. Circulation 2018; 138:e1-e34. [PMID: 29794080 DOI: 10.1161/cir.0000000000000580] [Citation(s) in RCA: 283] [Impact Index Per Article: 47.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
South Asians (from Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan, and Sri Lanka) make up one quarter of the world's population and are one of the fastest-growing ethnic groups in the United States. Although native South Asians share genetic and cultural risk factors with South Asians abroad, South Asians in the United States can differ in socioeconomic status, education, healthcare behaviors, attitudes, and health insurance, which can affect their risk and the treatment and outcomes of atherosclerotic cardiovascular disease (ASCVD). South Asians have higher proportional mortality rates from ASCVD compared with other Asian groups and non-Hispanic whites, in contrast to the finding that Asian Americans (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese) aggregated as a group are at lower risk of ASCVD, largely because of the lower risk observed in East Asian populations. Literature relevant to South Asian populations regarding demographics and risk factors, health behaviors, and interventions, including physical activity, diet, medications, and community strategies, is summarized. The evidence to date is that the biology of ASCVD is complex but is no different in South Asians than in any other racial/ethnic group. A majority of the risk in South Asians can be explained by the increased prevalence of known risk factors, especially those related to insulin resistance, and no unique risk factors in this population have been found. This scientific statement focuses on how ASCVD risk factors affect the South Asian population in order to make recommendations for clinical strategies to reduce disease and for directions for future research to reduce ASCVD in this population.
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Owusu Adjah ES, Bellary S, Hanif W, Patel K, Khunti K, Paul SK. Prevalence and incidence of complications at diagnosis of T2DM and during follow-up by BMI and ethnicity: a matched case-control analysis. Cardiovasc Diabetol 2018; 17:70. [PMID: 29764436 PMCID: PMC5952414 DOI: 10.1186/s12933-018-0712-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 05/04/2018] [Indexed: 12/19/2022] Open
Abstract
Aims To estimate the risk of developing long-term major cardiovascular and renal complications in relation to levels of body mass index (BMI) in a population of White European (WE), African-Caribbean (AC), and South Asian (SA) patients with type 2 diabetes mellitus (T2DM). Materials and methods Patients with new diagnosis of T2DM, aged ≥ 18 years from January 2000 (n = 69,436) and their age-sex-ethnicity matched non-diabetic controls (n = 272,190) were identified from UK primary care database. Incidence rates ratios (IRRs) for non-fatal major cardiovascular events (MACE) and chronic kidney disease (CKD) in patients with T2DM compared to controls were estimated using multivariate Mantel-Cox model. Results Among normal weight patients with T2DM, WEs had significantly higher prevalence of cardiovascular multi-morbidity (95% CI 9.5, 11.3), compared to SAs (95% CI 4.8, 9.5). AC and SA overweight and obese patients had similar prevalence, while obese WEs had significantly higher prevalence. During a median 7 years of follow-up, risk of MACE was significantly higher for overweight (95% CI of IRR 1.50, 2.46) and obese (95% CI of IRR 1.49, 2.43) SAs compared to their WE counterparts. However, similar risk levels were observed for normal weight WEs and SAs, respectively. Risk of CKD was higher and uniform for BMI ≥ 25 kg/m2 amongst WEs and ACs, whereas only overweight patients had significantly higher risk of CKD amongst SA [IRR 2.08 (95% CI 1.49, 2.93)]. Conclusion Risk of MACE/CKD varies over levels of BMI within each ethnic group, with overweight SAs having a disproportionate risk of CKD. Electronic supplementary material The online version of this article (10.1186/s12933-018-0712-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ebenezer S Owusu Adjah
- QIMR Berghofer Medical Research Institute, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Srikanth Bellary
- Aston Research Centre for Healthy Ageing, Aston University, Birmingham, UK
| | - Wasim Hanif
- Department of Diabetes, University Hospital Birmingham, Birmingham, UK
| | - Kiran Patel
- University of Warwick, Warwick, UK.,Heart of England NHS Trust, Birmingham, UK
| | - Kamlesh Khunti
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Sanjoy K Paul
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Australia.
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Geldsetzer P, Manne-Goehler J, Theilmann M, Davies JI, Awasthi A, Vollmer S, Jaacks LM, Bärnighausen T, Atun R. Diabetes and Hypertension in India: A Nationally Representative Study of 1.3 Million Adults. JAMA Intern Med 2018; 178:363-372. [PMID: 29379964 PMCID: PMC5885928 DOI: 10.1001/jamainternmed.2017.8094] [Citation(s) in RCA: 202] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
IMPORTANCE Understanding how diabetes and hypertension prevalence varies within a country as large as India is essential for targeting of prevention, screening, and treatment services. However, to our knowledge there has been no prior nationally representative study of these conditions to guide the design of effective policies. OBJECTIVE To determine the prevalence of diabetes and hypertension in India, and its variation by state, rural vs urban location, and individual-level sociodemographic characteristics. DESIGN, SETTING, AND PARTICIPANTS This was a cross-sectional, nationally representative, population-based study carried out between 2012 and 2014. A total of 1 320 555 adults 18 years or older with plasma glucose (PG) and blood pressure (BP) measurements were included in the analysis. EXPOSURES State, rural vs urban location, age, sex, household wealth quintile, education, and marital status. MAIN OUTCOMES AND MEASURES Diabetes (PG level ≥126 mg/dL if the participant had fasted or ≥200 mg/dL if the participant had not fasted) and hypertension (systolic BP≥140 mm Hg or diastolic BP≥90 mm Hg). RESULTS Of the 1 320 555 adults, 701 408 (53.1%) were women. The crude prevalence of diabetes and hypertension was 7.5% (95% CI, 7.3%-7.7%) and 25.3% (95% CI, 25.0%-25.6%), respectively. Notably, hypertension was common even among younger age groups (eg, 18-25 years: 12.1%; 95% CI, 11.8%-12.5%). Being in the richest household wealth quintile compared with being in the poorest quintile was associated with only a modestly higher probability of diabetes (rural: 2.81 percentage points; 95% CI, 2.53-3.08 and urban: 3.47 percentage points; 95% CI, 3.03-3.91) and hypertension (rural: 4.15 percentage points; 95% CI, 3.68-4.61 and urban: 3.01 percentage points; 95% CI, 2.38-3.65). The differences in the probability of both conditions by educational category were generally small (≤2 percentage points). Among states, the crude prevalence of diabetes and hypertension varied from 3.2% (95% CI, 2.7%-3.7%) to 19.9% (95% CI, 17.6%-22.3%), and 18.0% (95% CI, 16.6%-19.5%) to 41.6% (95% CI, 37.8%-45.5%), respectively. CONCLUSIONS AND RELEVANCE Diabetes and hypertension prevalence is high in middle and old age across all geographical areas and sociodemographic groups in India, and hypertension prevalence among young adults is higher than previously thought. Evidence on the variations in prevalence by state, age group, and rural vs urban location is critical to effectively target diabetes and hypertension prevention, screening, and treatment programs to those most in need.
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Affiliation(s)
- Pascal Geldsetzer
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Jennifer Manne-Goehler
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Michaela Theilmann
- Department of Economics & Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
| | - Justine I Davies
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Education Campus, University of Witwatersrand, Johannesburg, South Africa.,Centre for Global Health, King's College London, London, England
| | | | - Sebastian Vollmer
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Department of Economics & Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
| | - Lindsay M Jaacks
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Public Health Foundation of India, Delhi NCR, India
| | - Till Bärnighausen
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Institute of Public Health, Heidelberg University, Heidelberg, Germany.,Africa Health Research Institute, Mtubatuba, South Africa
| | - Rifat Atun
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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Misra R, Faiz O, Munkholm P, Burisch J, Arebi N. Epidemiology of inflammatory bowel disease in racial and ethnic migrant groups. World J Gastroenterol 2018; 24:424-437. [PMID: 29391765 PMCID: PMC5776404 DOI: 10.3748/wjg.v24.i3.424] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 11/15/2017] [Accepted: 11/21/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To summarise the current literature and define patterns of disease in migrant and racial groups.
METHODS A structured key word search in Ovid Medline and EMBASE was undertaken in accordance with PRISMA guidelines. Studies on incidence, prevalence and disease phenotype of migrants and races compared with indigenous groups were eligible for inclusion.
RESULTS Thirty-three studies met the inclusion criteria. Individual studies showed significant differences in incidence, prevalence and disease phenotype between migrants or race and indigenous groups. Pooled analysis could only be undertaken for incidence studies on South Asians where there was significant heterogeneity between the studies [95% for ulcerative colitis (UC), 83% for Crohn’s disease (CD)]. The difference between incidence rates was not significant with a rate ratio South Asian: Caucasian of 0.78 (95%CI: 0.22-2.78) for CD and 1.39 (95%CI: 0.84-2.32) for UC. South Asians showed consistently higher incidence and more extensive UC than the indigenous population in five countries. A similar pattern was observed for Hispanics in the United States. Bangladeshis and African Americans showed an increased risk of CD with perianal disease.
CONCLUSION This review suggests that migration and race influence the risk of developing inflammatory bowel disease. This may be due to different inherent responses upon exposure to an environmental trigger in the adopted country. Further prospective studies on homogenous migrant populations are needed to validate these observations, with a parallel arm for in-depth investigation of putative drivers.
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Affiliation(s)
- Ravi Misra
- Department of Gastroenterology, St. Marks Academic Institute, London HA1 3UJ, United Kingdom
| | - Omar Faiz
- Surgical Epidemiology, Trials and Outcome Centre, St. Marks Academic Institute, London HA1 3UJ, United Kingdom
| | - Pia Munkholm
- Department of Gastroenterology, North Zealand University Hospital, Frederikssund Frederikssundsvej 30, Denmark
| | - Johan Burisch
- Department of Gastroenterology, North Zealand University Hospital, Frederikssund Frederikssundsvej 30, Denmark
| | - Naila Arebi
- Department of Gastroenterology, St. Marks Academic Institute, London HA1 3UJ, United Kingdom
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Mechanick JI, Zhao S, Garvey WT. Leptin, An Adipokine With Central Importance in the Global Obesity Problem. Glob Heart 2017; 13:113-127. [PMID: 29248361 DOI: 10.1016/j.gheart.2017.10.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 10/25/2017] [Indexed: 02/08/2023] Open
Abstract
Leptin has central importance in the global obesity and cardiovascular disease problem. Leptin is principally secreted by adipocytes and acts in the hypothalamus to suppress appetite and food intake, increase energy expenditure, and regulate body weight. Based on clinical translation of specific and networked actions, leptin affects the cardiovascular system and may be a marker and driver of cardiometabolic risk factors with interventions that are actionable by cardiologists. Leptin subnetwork analysis demonstrates a statistically significant role for ethnoculturally and socioeconomically appropriate lifestyle intervention in cardiovascular disease. Emergent mechanistic components and potential diagnostic or therapeutic targets include hexokinase 3, urocortins, clusterin, sialic acid-binding immunoglobulin-like lectin 6, C-reactive protein, platelet glycoprotein VI, albumin, pentraxin 3, ghrelin, obestatin prepropeptide, leptin receptor, neuropeptide Y, and corticotropin-releasing factor receptor 1. Emergent associated symptoms include weight change, eating disorders, vascular necrosis, chronic fatigue, and chest pain. Leptin-targeted therapies are reported for lipodystrophy and leptin deficiency, but they are investigational for leptin resistance, obesity, and other chronic diseases.
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Affiliation(s)
- Jeffrey I Mechanick
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Shan Zhao
- Basepaws Inc., Redondo Beach, CA, USA
| | - W Timothy Garvey
- Department of Nutritional Sciences and Diabetes Research Center, University of Alabama at Birmingham, Birmingham, AL, USA; Geriatric Research Education and Clinical Center, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
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Collings PJ, Ball HL, Santorelli G, West J, Barber SE, McEachan RR, Wright J. Sleep Duration and Adiposity in Early Childhood: Evidence for Bidirectional Associations from the Born in Bradford Study. Sleep 2017; 40:2740619. [PMID: 28364513 PMCID: PMC5804981 DOI: 10.1093/sleep/zsw054] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Study Objectives: To examine independent associations of sleep duration with total and abdominal adiposity, and the bidirectionality of these associations, in a young biethnic sample of children from a disadvantaged location. Methods: Child sleep duration (h/day) was parent-reported by questionnaire and indices of total (body weight, body mass index, percent body fat (%BF), sum of skinfolds) and abdominal adiposity (waist circumference) were measured using standard anthropometric procedures at approximately 12, 18, 24, and 36 months of age in 1,338 children (58% South Asian; 42% White). Mixed effects models were used to quantify independent associations (expressed as standardised β-coefficients (95% confidence interval (CI)) of sleep duration with adiposity indices using data from all four time-points. Factors considered for adjustment in models included basic demographics, pregnancy and birth characteristics, and lifestyle behaviours. Results: With the exception of the sum of skinfolds, sleep duration was inversely and independently associated with indices of total and abdominal adiposity in South Asian children. For example, one standard deviation (SD) higher sleep duration was associated with reduced %BF by -0.029 (95% CI: −0.053, −0.0043) SDs. Higher adiposity was also independently associated with shorter sleep duration in South Asian children (for example, %BF: β = -0.10 (-0.16, -0.028) SDs). There were no significant associations in White children. Conclusions: Associations between sleep duration and adiposity are bidirectional and independent among South Asian children from a disadvantaged location. The results highlight the importance of considering adiposity as both a determinant of decreased sleep and a potential consequence.
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Affiliation(s)
- Paul J Collings
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Helen L Ball
- Parent-Infant Sleep Lab & Anthropology of Health Research Group, Department of Anthropology, Durham University, Durham
| | - Gillian Santorelli
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Jane West
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Sally E Barber
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Rosemary Rc McEachan
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - John Wright
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
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Verma AA, Jimenez MP, Subramanian S, Sniderman AD, Razak F. Race and Socioeconomic Differences Associated With Changes in Statin Eligibility Under the 2013 American College of Cardiology/American Heart Association Cholesterol Guidelines. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.117.003764. [DOI: 10.1161/circoutcomes.117.003764] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 08/08/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Amol A. Verma
- From the Department of Medicine (A.A.V.), Li Ka Shing Knowledge Institute, St. Michael’s Hospital (A.A.V., F.R.), and Division of General Internal Medicine, Department of Medicine (F.R.), University of Toronto, Ontario, Canada; Department of Epidemiology, Brown School of Public Health, Brown University, Providence, RI (M.P.J.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (S.V.S.); Division of Cardiology, Royal Victoria Hospital–McGill University Health
| | - Marcia P. Jimenez
- From the Department of Medicine (A.A.V.), Li Ka Shing Knowledge Institute, St. Michael’s Hospital (A.A.V., F.R.), and Division of General Internal Medicine, Department of Medicine (F.R.), University of Toronto, Ontario, Canada; Department of Epidemiology, Brown School of Public Health, Brown University, Providence, RI (M.P.J.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (S.V.S.); Division of Cardiology, Royal Victoria Hospital–McGill University Health
| | - S.V. Subramanian
- From the Department of Medicine (A.A.V.), Li Ka Shing Knowledge Institute, St. Michael’s Hospital (A.A.V., F.R.), and Division of General Internal Medicine, Department of Medicine (F.R.), University of Toronto, Ontario, Canada; Department of Epidemiology, Brown School of Public Health, Brown University, Providence, RI (M.P.J.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (S.V.S.); Division of Cardiology, Royal Victoria Hospital–McGill University Health
| | - Allan D. Sniderman
- From the Department of Medicine (A.A.V.), Li Ka Shing Knowledge Institute, St. Michael’s Hospital (A.A.V., F.R.), and Division of General Internal Medicine, Department of Medicine (F.R.), University of Toronto, Ontario, Canada; Department of Epidemiology, Brown School of Public Health, Brown University, Providence, RI (M.P.J.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (S.V.S.); Division of Cardiology, Royal Victoria Hospital–McGill University Health
| | - Fahad Razak
- From the Department of Medicine (A.A.V.), Li Ka Shing Knowledge Institute, St. Michael’s Hospital (A.A.V., F.R.), and Division of General Internal Medicine, Department of Medicine (F.R.), University of Toronto, Ontario, Canada; Department of Epidemiology, Brown School of Public Health, Brown University, Providence, RI (M.P.J.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (S.V.S.); Division of Cardiology, Royal Victoria Hospital–McGill University Health
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Hudgins LC, Hugo JL, Enayat S, Parker TS, Artis AS, Levine DM. Young, healthy South Asians have enhanced lipogenic sensitivity to dietary sugar. Clin Endocrinol (Oxf) 2017; 86:361-366. [PMID: 27988942 DOI: 10.1111/cen.13293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 11/16/2016] [Accepted: 12/11/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE South Asians have higher rates of type 2 diabetes and cardiovascular disease compared to most other racial/ethnic groups. Increased hepatic de novo lipogenesis (DNL) in response to dietary sugar may accelerate the development of these chronic diseases in this population. STUDY DESIGN Hepatic DNL in response to a calorically sweetened beverage was measured in an outpatient setting in 15 South Asians and 15 Caucasians with similar and normal body mass indexes, waist circumferences, glucose tolerance and lipid profiles. Blood was sampled before and hourly for 4 h after the ingestion of a single beverage made with glucose (1·5 g/kg) and fructose (1·5 g/kg). The main outcome, DNL, was measured as the increase in %palmitate (16:0) in very low-density lipoprotein (VLDL) triglyceride (TG) over 4 h. RESULTS After the sugar dose, the increase in %16:0 in VLDL TG was significantly greater in South Asians vs Caucasians (P = 0·01). VLDL and total TG also increased to a significantly greater extent in South Asians (P = 0·04 and <0·001, respectively). Although the fasting and postsugar levels of insulin and glucose did not differ between groups, the DNL response significantly correlated with the insulin response to sugar in South Asians (r = 0·56, P = 0·03). CONCLUSIONS Hepatic DNL in response to a sugar challenge was greater in healthy, young South Asians compared to Caucasians despite normal indices of insulin sensitivity, and it correlated with the insulin response. These findings suggest an early, insulin-related, gene-nutrient interaction contributing to the high prevalence of diabetes and coronary disease in this population.
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Affiliation(s)
- Lisa C Hudgins
- The Rogosin Institute, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | | | - Samim Enayat
- Weill Cornell Medical College, New York, NY, USA
| | - Thomas S Parker
- The Rogosin Institute, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | | | - Daniel M Levine
- The Rogosin Institute, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
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Schulman-Marcus J, Heo R, Gransar H, Suwaidi JA, Alkuwari M, Elmore K, Gomez MJ, Jayyousi A, Zirie M, Min JK, Peña JM. Subclinical atherosclerosis detected by coronary computed tomographic angiography in Qatar: a comparison between Qataris and south Asian migrants. Int J Cardiovasc Imaging 2017; 33:927-935. [PMID: 28130645 DOI: 10.1007/s10554-017-1073-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 01/12/2017] [Indexed: 01/14/2023]
Abstract
PURPOSE There are limited data regarding subclinical atherosclerosis in Middle Eastern countries. We aimed to describe and compare coronary computed tomographic angiography (CCTA) findings in Qatari native and South Asian migrants at increased risk of coronary artery disease (CAD). METHODS We performed CCTA in 251 consecutive volunteers (126 South Asian, 125 Qatari, mean age 50.0 ± 7.3 years, 27.1% female) at increased risk of cardiovascular disease. Given differences in baseline risk factors, we employed propensity score matching to create a cohort of 162 subjects for comparative analyses. We compared CAD severity, extent, plaque morphology, adverse plaque characteristics, and quantitative measures of atherosclerotic burden in both subgroups. RESULTS After matching, no CAD was seen in 58.0% of South Asians and 49.4% of Qataris (p = 0.3), while obstructive CAD (≥50% luminal stenosis) was present in 40.7% of South Asians and 49.4% of Qataris (p = 0.3). There was a high prevalence of adverse plaque characteristics in both ethnicities, particularly positive remodeling. South Asians had significantly smaller vessel and lumen volumes, but the percent aggregate plaque volumes were not significantly different (2.9 ± 6.3% vs. 3.8 ± 8.0%, p = 0.4). CONCLUSIONS In this first study of CCTA findings performed in a Middle Eastern country, we observed a high prevalence of obstructive CAD in a middle-aged cohort. There were no significant differences in CCTA findings between Qataris and South Asians after adjustment for clinical risk factors. Future studies are needed to identify patterns of coronary atherosclerosis by CCTA in non-European populations where cardiovascular disease is increasingly prevalent.
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Affiliation(s)
- Joshua Schulman-Marcus
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and New York Presbyterian Hospital, 413 East 69th Street, Suite 108, New York, NY, 10021, USA.,Division of Cardiology, Albany Medical Center, Albany, NY, USA
| | - Ran Heo
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Heidi Gransar
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Kimberly Elmore
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and New York Presbyterian Hospital, 413 East 69th Street, Suite 108, New York, NY, 10021, USA
| | - Mille J Gomez
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and New York Presbyterian Hospital, 413 East 69th Street, Suite 108, New York, NY, 10021, USA
| | | | | | - James K Min
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and New York Presbyterian Hospital, 413 East 69th Street, Suite 108, New York, NY, 10021, USA
| | - Jessica M Peña
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and New York Presbyterian Hospital, 413 East 69th Street, Suite 108, New York, NY, 10021, USA.
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Tran KC, Leung AA, Tang KL, Quan H, Khan NA. Efficacy of Calcium Channel Blockers on Major Cardiovascular Outcomes for the Treatment of Hypertension in Asian Populations: A Meta-analysis. Can J Cardiol 2017; 33:635-643. [PMID: 28377067 DOI: 10.1016/j.cjca.2017.01.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 01/12/2017] [Accepted: 01/12/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Whether calcium channel blockers exert a greater effect on cardiovascular risk reduction in Asian populations than other antihypertensive agents is unclear. We conducted a meta-analysis of hypertension trials of dihydropyridine calcium channel blockers in Asian populations to clarify this association. METHODS EMBASE, MEDLINE, and Cochrane databases were searched (from inception to August 2016) for randomized controlled trials on cardiovascular death, major adverse cardiovascular events, stroke, congestive heart failure, and coronary revascularization in Asian persons with hypertension. We identified 9 trials that reported data specific to Asian populations (N = 29,643). These trials included 1 placebo-controlled trial and 8 active comparator trials; of these, 5 had angiotensin receptor blockers as the active comparator. RESULTS One placebo-controlled trial (n = 9711) showed significantly reduced cardiovascular mortality, major adverse cardiovascular events, and stroke with calcium channel blockers. Among 8 active comparator trials (n = 19,932), there were no significant differences in mortality (relative risk [RR], 1.10; 95% confidence interval [CI], 0.72-1.67; I2 = 0.0%), major adverse cardiovascular events (RR, 1.02; 95% CI, 0.90-1.15; I2 = 0.0%), stroke (RR, 0.97; 95% CI, 0.80-1.17; I2 = 0.0%), congestive heart failure (RR, 1.01; 95% CI, 0.51-2.00; I2 = 53.7), or coronary revascularization rates (RR, 0.98; 95% CI, 0.76-1.25; I2 = 0.0%) in the calcium channel blocker group compared with other antihypertensive agents. When restricting the meta-analysis to angiotensin receptor blocker comparators (n = 10,384), there were no significant differences in cardiovascular outcomes. CONCLUSIONS There is no evidence that dihydropyridine calcium channel blockers are superior to other antihypertensive agents in Asian populations for the treatment of hypertension.
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Affiliation(s)
- Karen C Tran
- Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Alexander A Leung
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Karen L Tang
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Hude Quan
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Nadia A Khan
- Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
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Akboga MK, Yalcin R, Sahinarslan A, Yilmaz Demirtas C, Abaci A. Effect of serum YKL-40 on coronary collateral development and SYNTAX score in stable coronary artery disease. Int J Cardiol 2016; 224:323-327. [DOI: 10.1016/j.ijcard.2016.09.042] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 09/10/2016] [Accepted: 09/15/2016] [Indexed: 12/19/2022]
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Kraker J, Viswanathan SK, Knöll R, Sadayappan S. Recent Advances in the Molecular Genetics of Familial Hypertrophic Cardiomyopathy in South Asian Descendants. Front Physiol 2016; 7:499. [PMID: 27840609 PMCID: PMC5083855 DOI: 10.3389/fphys.2016.00499] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 10/12/2016] [Indexed: 12/14/2022] Open
Abstract
The South Asian population, numbered at 1.8 billion, is estimated to comprise around 20% of the global population and 1% of the American population, and has one of the highest rates of cardiovascular disease. While South Asians show increased classical risk factors for developing heart failure, the role of population-specific genetic risk factors has not yet been examined for this group. Hypertrophic cardiomyopathy (HCM) is one of the major cardiac genetic disorders among South Asians, leading to contractile dysfunction, heart failure, and sudden cardiac death. This disease displays autosomal dominant inheritance, and it is associated with a large number of variants in both sarcomeric and non-sarcomeric proteins. The South Asians, a population with large ethnic diversity, potentially carries region-specific polymorphisms. There is high variability in disease penetrance and phenotypic expression of variants associated with HCM. Thus, extensive studies are required to decipher pathogenicity and the physiological mechanisms of these variants, as well as the contribution of modifier genes and environmental factors to disease phenotypes. Conducting genotype-phenotype correlation studies will lead to improved understanding of HCM and, consequently, improved treatment options for this high-risk population. The objective of this review is to report the history of cardiovascular disease and HCM in South Asians, present previously published pathogenic variants, and introduce current efforts to study HCM using induced pluripotent stem cell-derived cardiomyocytes, next-generation sequencing, and gene editing technologies. The authors ultimately hope that this review will stimulate further research, drive novel discoveries, and contribute to the development of personalized medicine with the aim of expanding therapeutic strategies for HCM.
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Affiliation(s)
- Jessica Kraker
- Department of Internal Medicine, Heart, Lung and Vascular Institute, Division of Cardiovascular Health and Sciences, University of Cincinnati College of Medicine Cincinnati, OH, USA
| | - Shiv Kumar Viswanathan
- Department of Internal Medicine, Heart, Lung and Vascular Institute, Division of Cardiovascular Health and Sciences, University of Cincinnati College of Medicine Cincinnati, OH, USA
| | - Ralph Knöll
- AstraZeneca R&D Mölndal, Innovative Medicines and Early Development, Cardiovascular and Metabolic Diseases iMedMölndal, Sweden; Integrated Cardio Metabolic Centre, Karolinska Institutet, Myocardial Genetics, Karolinska University Hospital in HuddingeHuddinge, Sweden
| | - Sakthivel Sadayappan
- Department of Internal Medicine, Heart, Lung and Vascular Institute, Division of Cardiovascular Health and Sciences, University of Cincinnati College of Medicine Cincinnati, OH, USA
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