Ethnicity and risk factors for coronary heart disease in diabetes mellitus

The Framingham equation can be used to predict the risk of coronary heart disease (CHD) and so to target risk factor intervention. Reservations have been applied to its use in south Asian populations since the high CHD mortality in this group may not be accounted for by traditional risk factors.

We applied the Framingham equation to 1826 patients with diabetes of whom 1215 were of white Caucasian and 611 south Asian origin. Having calculated the 10-year CHD risks the contribution of risk factors were compared between ethnic groups.

Mean 10-year CHD risk was the same in the two ethnic groups (20.7 vs. 21.5%, white Caucasian vs. south Asian men and 16.5 vs. 15.9%, white Caucasian vs. south Asian women). However, the risk factor profile was different between the two groups. Mean total cholesterol was lower in south Asians (5.23 vs. 5.41 mmol/l, south Asian vs. white Caucasian men (p = 0.01) and 5.38 vs. 5.68 mmol/l, south Asian vs. white Caucasian women (p < 0.001)). HDL cholesterol levels were also lower (median HDL cholesterol 0.94 vs. 1.11 mmol/l, south Asian vs. white Caucasian men (p < 0.001) and 1.07 vs. 1.3 mmol/l, south Asian vs. white Caucasian women (p < 0.0001)) leading to higher total: HDL cholesterol ratios (5.48 vs. 4.78, south Asian vs. white Caucasian men (p = 0.032) and 4.91 vs. 4.26, south Asian vs. white Caucasian women (p < 0.001).

Calculated 10-year CHD risks are the same in south Asian and white Caucasian diabetic patients but the factors contributing to this risk differ. Different management of these risk factors may account for the higher mortality from CHD in those of south Asian origin.