Electronic letters to:

Research:
Milan Gupta, Anand V. Doobay, Narendra Singh, Sonia S. Anand, Faisal Raja, Fazeelat Mawji, Julian Kho, Alice Karavetian, Qilong Yi, and Salim Yusuf
Risk factors, hospital management and outcomes after acute myocardial infarction in South Asian Canadians and matched control subjects
CMAJ 2002; 166: 717-722 [Abstract] [Full text] [PDF]
*eLetters: Submit a response to this article

Electronic letters published:

[Read eLetter] Cardiovascular Disease and South Asians.
Vivian S Rambihar   (1 May 2002)

Cardiovascular Disease and South Asians. 1 May 2002
Top
Vivian S Rambihar,
cardiologist
The Scarborough Hospital, Toronto.

Send letter to journal:
Re: Cardiovascular Disease and South Asians.

vashna{at}rogers.com Vivian S Rambihar

In their discussion on risk factors and myocardial infarction in South Asians (SA) (1) Gupta et al omit some important issues.

Lp(a) and homocysteine levels, reported higher in South Asians (2) and with multiplicative risk may partially explain their excess cardiovascular disease (CVD) (3). Although not measured in this study it warrants discussion because of risk amplification of conventional risk factors, with implications for care.

Excess premature CVD (men < 55 years, women < 65 years), a crucial feature of CVD in SA, with implications for screening, prevention and treatment merits discussion. Recognized across the SA diaspora (3), this was previously reported for SA men and women admitted with Acute Myocardial Infarctions to a Toronto hospital from 1990-‘95 (4,5). The expected ten year delay in onset of heart disease in women was reduced for SA women to 4.2 years mean (2.0 years median). Premature CVD should thus probably be specifically examined and reported in studies on SA.

Gupta mentions that “it is encouraging to note the recent emergence of ethnicity-based research in this country.” Such research has existed in Canada for two decades, including a Conference on Heart Disease in IndoCaribbean People in 1990, a Multicultural Cardiology Conference in Toronto in 1993, a Commentary on Ethnocultural Heart and an Editorial on CVD and SA in the Canadian Journal of Cardiology in 1995, the prior report of AMI in Toronto, an International Nursing Symposium, together with numerous lectures and events across Canada for over a decade. Thus such research is more than encouraging and certainly not recent.

References:

1)Gupta M, Doobay AV, Singh N, Anand SS, Raja F, Mawji F, et al. Risk factors, hospital management and outcomes following myocardial infarction in South Asian Canadians and matched control subjects. CMAJ 2002;166(6):717-22.

2)Anand SS, Yusuf S, Vuksan V, Devanesen D, Teo KK, Montague PA, et al. Difference in risk factors, atherosclerosis, and cardiovascular disease between ethnic groups in Canada: the Study of Health Assessment and Risk in Ethnic Groups (SHARE). Lancet 2000;356:279-84.

3)Rambihar VS. SOUTH ASIAN HEART: Preventing Heart Disease: from the heart to the edge of the diaspora. Toronto. Vashna. 1996, 2002.

4)Rambihar VS, Wilson JL, Jagdeo DG. Ethnic Variation and Coronary Artery Disease. Can J Cardiol 1997;13 (Suppl B):241B.

5)Rambihar SP, Rambihar V, Wilson J, Jagdeo DG, Vali Y, Chung W. Women, Ethnic Variation and CAD. Can J Cardiol 2000;16(Suppl B):49B.

VS Rambihar. Cardiologist. The Scarborough Hospital, Toronto.