THE HIGH CORONARY DISEASE RISK OF SOUTH ASIAN AMERICANS
Arthur L. Klatsky, M.D., Kaiser Permanente Medical Center, Oakland, CA, USA
Objective and Background: Prevalence data and case-control studies suggest high coronary artery disease (CAD) risk in South Asians (SA) but prospective studies remain sparse. We performed a comprehensive prospective analysis in a large population.
Methods: We studied incident CAD hospitalizations in a multi-ethnic California cohort of 126,088 persons that supplied baseline data in 1978-85. Cox proportional hazards models adjusted for 11 covariates (age, sex, smoking, alcohol, BMI, education, marital status, blood pressure, blood cholesterol, blood glucose, and leukocyte count) were used to study 7,658 persons hospitalized for CAD through 2008. The models yielded hazard ratios (HR) and 95% confidence intervals (CI).
Results: For CAD the adjusted HR (CI) for SAs versus white persons was 2.32 (1.76-1.84, p<0.001). For other Asian American ethnic groups the HRs were: Chinese = 0.74 (p<0.001, Japanese = 0.84 (p=0.1) Filipino = 1.14 (p=0.048), and Other Asian = 0.76 (p=0.2). The SA risk of CAD was substantially higher in separate models versus blacks, Hispanics, and each other Asian group, ranging from a HR of 2.3 vs Filipinos to 3.3 vs Chinese and with p<0.001 vs each. There was also consistency in models stratified by sex, baseline age, smoking, presence of baseline CAD history/symptoms, or acute myocardial infarction/other CAD.
Conclusions: South Asian Americans are at substantially higher risk than any other ethnic group. While unexplained, the findings warrant vigorous public health action.