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Canadian Journal of Cardiology

Cardiovascular Disease in South Asian Migrants

  • Author Footnotes
    ∗ These authors contributed equally to this work.
    Eshan Fernando
    Footnotes
    ∗ These authors contributed equally to this work.
    Affiliations
    Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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  • Author Footnotes
    ∗ These authors contributed equally to this work.
    Fahad Razak
    Footnotes
    ∗ These authors contributed equally to this work.
    Affiliations
    Department of Medicine, University of Toronto, Toronto, Ontario, Canada

    Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada

    Harvard Center for Population and Development Studies, Boston, Massachusetts, USA
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  • Scott A. Lear
    Affiliations
    Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada

    Division of Cardiology, Providence Health Care, Vancouver, British Columbia, Canada
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  • Sonia S. Anand
    Correspondence
    Corresponding author: Dr Sonia S. Anand, McMaster University, 1280 Main St W, MDCL-3204, Hamilton, Ontario L8S 4K1, Canada. Tel.: +1-905-525-9140 × 21523; fax: +1-905-528-2814.
    Affiliations
    Department of Medicine, McMaster University, Hamilton, Ontario, Canada

    Department of Epidemiology, McMaster University, Hamilton, Ontario, Canada

    Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada

    Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada
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  • Author Footnotes
    ∗ These authors contributed equally to this work.

      Abstract

      Cardiovascular disease (CVD) represents a significant cause of global mortality and morbidity. South Asians (SAs) have a particularly high burden of coronary artery disease (CAD). This review describes current literature regarding the prevalence, incidence, etiology, and prognosis of CVD in SA migrants to high-income nations. We conducted a narrative review of CVD in the SA diaspora through a search of MEDLINE and PubMed. We included observational studies, randomized clinical trials, nonsystematic reviews, systematic reviews, and meta-analyses written in English. Of 15,231 articles identified, 827 articles were screened and 124 formed the basis for review. SA migrants have a 1.5-2 times greater prevalence of CAD than age- and sex-adjusted Europids. Increased abdominal obesity and body fat and increased burden of type 2 diabetes mellitus and dyslipidemia appear to be primary drivers of the excess CAD burden in SAs. Sedentary lifestyle and changes in diet after immigration are important contributors to weight gain and adiposity. Early life factors, physical activity patterns and, in some cases, reduced adherence to medical therapy may contribute to increased CVD risks in SAs. Novel biomarkers like leptin and adipokines may show distinct patterns in SAs and provide insights into cardiometabolic risk determinants. In conclusion, SAs have distinct CVD risk predispositions, with a complex relationship to cultural, innate, and acquired factors. Although CVD risk factor management and treatment among SAs is improving, opportunities exist for further advances.

      Résumé

      Les maladies cardiovasculaires (MCV) représentent une cause importante de mortalité et de morbidité mondiales. Les Sud-Asiatiques (SA) ont un niveau particulièrement élevé de maladie coronarienne. Cette revue compile la littérature actuelle concernant la prévalence, l'incidence, l'étiologie et le pronostic des MCV chez les migrants SA vers les pays à revenu élevé. Nous avons effectué un examen narratif des MCV dans la diaspora SA via une recherche dans MEDLINE et PubMed. Nous avons inclus des études d'observation, des essais cliniques randomisés, des revues non systématiques, des revues systématiques et des méta-analyses écrites en anglais. À partir de 15 231 articles identifiés, 827 articles ont été examinés et 124 ont formé la base pour la revue. Les migrants SA ont une prévalence de maladie coronarienne 1,5 à 2 fois plus grande que les europoïdes, ajusté pour l’âge et le sexe. L’augmentation de l'obésité abdominale et du gras corporel, et l'augmentation de la charge du diabète de type 2 et la dyslipidémie semblent être le principal moteur de la charge excessive de la maladie coronarienne chez les SA. Un mode de vie sédentaire et des changements de régime alimentaire après l'immigration sont d’importants contributeurs à la prise de poids et l'adiposité. Des facteurs des stades précoces de l’existence, la façon de pratiquer une activité physique et, dans certains cas, une observance réduite du traitement médical peuvent contribuer à l'augmentation des risques de MCV chez les SA. De nouveaux biomarqueurs telles la leptine et les adipokines peuvent montrer des modèles distincts chez les SA et fournir des indications sur les déterminants du risque cardiométabolique. En conclusion, les SA ont des prédispositions distinctes de risque de MCV, avec une intrication complexe de facteurs culturels, innés et acquis. Bien que la gestion des facteurs de risque des MCV et leur traitement chez les SA s’améliore, des possibilités demeurent pour des avancées ultérieures.
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