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Cardiovascular diseases in Chinese, Malays, and Indians in Singapore. II. Differences in risk factor levels
1National University of Singapore, Department of Community, Occupational and Family Medicine.
Insights
Cardiovascular disease mortality differences among ethnic groups in Singapore are not fully explained by major risk factors. Lower high-density lipoprotein cholesterol and higher diabetes rates may contribute to Indian mortality, while higher blood pressure may affect Malay mortality.
Area of Science:
- Public Health
- Epidemiology
- Cardiovascular Disease Research
Background:
- Ethnic disparities in cardiovascular disease (CVD) mortality exist in Singapore.
- Understanding the role of cardiovascular risk factors is crucial for targeted interventions.
Purpose of the Study:
- To investigate cardiovascular risk factors and their association with CVD mortality differences among Chinese, Malays, and Indians in Singapore.
Main Methods:
- A population-based cross-sectional survey was conducted in Singapore.
- Stratified systematic sampling was used to recruit 2143 subjects aged 18-69.
- Data on smoking, blood pressure, lipids, and glucose were collected via questionnaire and measurements.
Main Results:
- Malays showed higher age-adjusted smoking rates and systolic blood pressure compared to Chinese and Indians.
- Indians had the highest age-adjusted prevalence of diabetes (males) and lower high-density lipoprotein cholesterol (HDL-C) in both sexes.
- No significant ethnic differences were observed in serum cholesterol or low-density lipoprotein cholesterol (LDL-C).
Conclusions:
- Major risk factors like smoking, blood pressure, and cholesterol do not fully explain higher ischemic heart disease mortality in Indians.
- Lower HDL-C and higher diabetes rates may contribute to increased CVD risk in the Indian population.
- Elevated systolic blood pressure in Malays might explain their higher hypertensive disease mortality.
Study Objective:
The aim of the study was to examine cardiovascular risk factors to see how these might explain differences in cardiovascular disease mortality among Chinese, Malays, and Indians in the Republic of Singapore.
Design:
The study was a population based cross sectional survey. Stratified systematic sampling of census districts, reticulated units, and houses was used. The proportions of Malay and Indian households were increased to improve statistical efficiency, since about 75% of the population is Chinese.
Setting:
Subjects were recruited from all parts of the Republic of Singapore.
Subjects:
2143 subjects aged 18 to 69 years were recruited (representing 60.3% of persons approached). There were no differences in response rate between the sexes and ethnic groups.
Measurements And Main Results:
Data on cardiovascular risk factors were collected by questionnaire. Measurements were made of blood pressure, serum cholesterol, low and high density lipoprotein cholesterol, fasting triglycerides and plasma glucose. In males the age adjusted cigarette smoking rate was higher in Malays (53.3%) than in Chinese (37.4%) or Indians (44.5%). In both sexes, Malays had higher age adjusted mean systolic blood pressure: males 124.6 mm Hg v 121.2 mm Hg (Chinese) and 121.2 mm Hg (Indians); females 122.8 mm Hg v 117.3 mm Hg (Chinese) and 118.4 mm Hg (Indians). Serum cholesterol, low density lipoprotein cholesterol and triglyceride showed no ethnic differences. Mean high density lipoprotein cholesterol in males (age adjusted) was lower in Indians (0.69 mmol/litre) than in Chinese (0.87 mmol/litre) and Malays (0.82 mmol/litre); in females the mean value of 0.95 mmol/litre in Indians was lower than in Chinese (1.05 mmol/litre) and Malays (1.03 mmol/litre). Rank prevalence of diabetes for males was Indians (highest), Malays and then Chinese; for females it was Malays, Indians, Chinese.
Conclusions:
The higher mortality from ischaemic heart disease found in Indians in Singapore cannot be explained by the major risk factors of cigarette smoking, blood pressure and serum cholesterol; lower high density lipoprotein cholesterol and higher rates of diabetes may be part of the explanation. The higher systolic blood pressures in Malays may explain their higher hypertensive disease mortality.
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