Risk stratification of coronary heart disease in UK South Asians

It is clear that South Asians living in the West have substantially greater relative (coronary heart disease) CHD mortality and morbidity than the general population. Despite this current risk functions based on classical risk factors alone underestimate risk in non-diabetic South Asians. After reviewing the available literature for longitudinal studies exploring the relationship between South Asian ethnicity, as an independent factor, and CHD an adjustment factor suitable for use with the paper- based risk prediction functions was derived. The exploration of possible explanations for the excess risk identified dysglycaemia as one possible explain. Adding 10 years to age, although crude and based on the single prospective study, provides adequate sensitivity and specificity to take into account an "ethnicity factor" accounting for average excess risk in individual UK South Asians. Using this adjustment it was shown that more South Asian men and women, living in the UK, are candidates to receive lipid-lowering therapy for primary and secondary prevention than their Caucasian counterparts. Although the evidence base for a CVD risk estimation procedure in South Asians is slight it is better that they have their risk estimated, albeit with less precision, than be excluded. The present work provides a properly researched evidence base. Moreover, it provides its own very simple, but 1. practice acceptable, adjustment for currently used paper risk estimation tools. Acceptance of ant1hypertensives as a primary prevention treatment was looked at in the South Asians community. South Asians are at least equally accepting of treatment as Caucasians when given information about the personal impact of CVD and the effect and tolerability of antihypertensive treatment. With South Asians having a greater need and at least equal acceptance of preventive therapy, they should receive more such treatment. Current evidence suggests that this is not the case and targeted intervention may be needed. Further research is still required in many areas such as risk factors, risk estimation and recalibration, lifestyle intervention, and efficacy of preventive drug therapy in ethnic minorities. Because this population is at high risk, the benefits of appropriate research will also be high.