Skip to main content
NCBI home page
British Heart Journal logoLink to British Heart Journal
. 1994 Nov;72(5):413–421. doi: 10.1136/hrt.72.5.413

Insulin resistance, high prevalence of diabetes, and cardiovascular risk in immigrant Asians. Genetic or environmental effect?

J Dhawan 1, C L Bray 1, R Warburton 1, D S Ghambhir 1, J Morris 1
PMCID: PMC1025607  PMID: 7818957

Abstract

OBJECTIVES--To compare the prevalence of diabetes, hyperinsulinaemia, and associated metabolic abnormalities in immigrant Asians, Asians in India, and native white British men. DESIGN--Case control study. SETTING--Wythenshawe Hospital, Manchester, United Kingdom, and Maulana Azad Medical School, New Delhi, India. SUBJECTS--Men with angiographically proved coronary artery disease; 83 British Asians, 87 white men, and 30 Indian Asians with age matched controls. INTERVENTIONS--Fasting lipid concentrations, serum glucose, and total insulin concentrations were measured in the fasting state and one and two hours after a 75 g glucose load by mouth. All subjects had a physical examination by the same observer. RESULTS--Asians in the United Kingdom and in India had a higher prevalence of diabetes and impaired glucose tolerance than the white British men. Patients in all three ethnic groups had higher total insulin concentrations than their controls in the fasting state and after the glucose load. British Asian and Indian Asian patients and controls had higher total insulin concentrations than the white men in the fasting state and after the glucose load. Total insulin concentrations were similar in British and Indian Asians, though fasting concentrations were higher in British Asians than Indian Asians. White men had similar cholesterol, lower triglyceride, and higher high density lipoprotein cholesterol concentrations than Asians in the United Kingdom and in India. British Asian patients had higher cholesterol concentrations and British Asian controls had higher triglyceride concentrations than the Indian Asian groups. Asian patients and controls were more active. British and Indian Asian patients had higher waist to hip ratios than controls. The waist to hip ratio was positively correlated with insulin and triglyceride concentrations and negatively correlated with the high density lipoprotein cholesterol concentration. Fasting insulin and high density lipoprotein concentrations were independent predictors of coronary artery disease in white men, whereas in British Asians the waist to hip ratio was the strongest independent predictor. In Indian Asians the waist to hip ratio and high density lipoprotein concentration were independent predictors of coronary artery disease. CONCLUSIONS--Central obesity in the subgroups of Asians studied showed a close association with hyperinsulinaemia and the risk of coronary artery disease. A predisposition to insulin resistance and its metabolic abnormalities in this group of Asians seems to be genetically determined, environmental changes after migration having only a small additional effect.

Full text

PDF
413

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bainton D., Burns-Cox C. J., Elwood P. C., Lewis B., Miller N. E., Morgan K., Sweetnam P. M. Prevalence of ischaemic heart disease and associations with serum lipoproteins in subjects aged 45 to 64 years. The Speedwell study. Br Heart J. 1982 May;47(5):483–489. doi: 10.1136/hrt.47.5.483. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Balarajan R., Bulusu L., Adelstein A. M., Shukla V. Patterns of mortality among migrants to England and Wales from the Indian subcontinent. Br Med J (Clin Res Ed) 1984 Nov 3;289(6453):1185–1187. doi: 10.1136/bmj.289.6453.1185. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Banskota N. K., Taub R., Zellner K., Olsen P., King G. L. Characterization of induction of protooncogene c-myc and cellular growth in human vascular smooth muscle cells by insulin and IGF-I. Diabetes. 1989 Jan;38(1):123–129. doi: 10.2337/diab.38.1.123. [DOI] [PubMed] [Google Scholar]
  4. Evans D. J., Hoffmann R. G., Kalkhoff R. K., Kissebah A. H. Relationship of body fat topography to insulin sensitivity and metabolic profiles in premenopausal women. Metabolism. 1984 Jan;33(1):68–75. doi: 10.1016/0026-0495(84)90164-1. [DOI] [PubMed] [Google Scholar]
  5. Fujimoto W. Y., Akanuma Y., Kanazawa Y., Mashiko S., Leonetti D., Wahl P. Plasma insulin levels in Japanese and Japanese-American men with type 2 diabetes may be related to the occurrence of cardiovascular disease. Diabetes Res Clin Pract. 1989 Feb 15;6(2):121–127. doi: 10.1016/0168-8227(89)90116-2. [DOI] [PubMed] [Google Scholar]
  6. Grimm R. H., Jr, Leon A. S., Hunninghake D. B., Lenz K., Hannan P., Blackburn H. Effects of thiazide diuretics on plasma lipids and lipoproteins in mildly hypertensive patients: a double-blind controlled trial. Ann Intern Med. 1981 Jan;94(1):7–11. doi: 10.7326/0003-4819-94-1-7. [DOI] [PubMed] [Google Scholar]
  7. Hughes L. O., Cruickshank J. K., Wright J., Raftery E. B. Disturbances of insulin in British Asian and white men surviving myocardial infarction. BMJ. 1989 Aug 26;299(6698):537–541. doi: 10.1136/bmj.299.6698.537. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Hughes L. O., Raval U., Raftery E. B. First myocardial infarctions in Asian and white men. BMJ. 1989 May 20;298(6684):1345–1350. doi: 10.1136/bmj.298.6684.1345. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Jajoo U. N., Kalantri S. P., Gupta O. P., Jain A. P., Gupta K. The prevalence of coronary heart disease in rural population from central India. J Assoc Physicians India. 1988 Dec;36(12):689–693. [PubMed] [Google Scholar]
  10. Kleinman K. S., Fine L. G. Prognostic implications of renal hypertrophy in diabetes mellitus. Diabetes Metab Rev. 1988 Mar;4(2):179–189. doi: 10.1002/dmr.5610040207. [DOI] [PubMed] [Google Scholar]
  11. Knight T. M., Smith Z., Whittles A., Sahota P., Lockton J. A., Hogg G., Bedford A., Toop M., Kernohan E. E., Baker M. R. Insulin resistance, diabetes, and risk markers for ischaemic heart disease in Asian men and non-Asian in Bradford. Br Heart J. 1992 May;67(5):343–350. doi: 10.1136/hrt.67.5.343. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Lapidus L., Bengtsson C., Larsson B., Pennert K., Rybo E., Sjöström L. Distribution of adipose tissue and risk of cardiovascular disease and death: a 12 year follow up of participants in the population study of women in Gothenburg, Sweden. Br Med J (Clin Res Ed) 1984 Nov 10;289(6454):1257–1261. doi: 10.1136/bmj.289.6454.1257. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Larsson B., Svärdsudd K., Welin L., Wilhelmsen L., Björntorp P., Tibblin G. Abdominal adipose tissue distribution, obesity, and risk of cardiovascular disease and death: 13 year follow up of participants in the study of men born in 1913. Br Med J (Clin Res Ed) 1984 May 12;288(6428):1401–1404. doi: 10.1136/bmj.288.6428.1401. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. McKeigue P. M., Marmot M. G. Mortality from coronary heart disease in Asian communities in London. BMJ. 1988 Oct 8;297(6653):903–903. doi: 10.1136/bmj.297.6653.903. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. McKeigue P. M., Marmot M. G., Syndercombe Court Y. D., Cottier D. E., Rahman S., Riemersma R. A. Diabetes, hyperinsulinaemia, and coronary risk factors in Bangladeshis in east London. Br Heart J. 1988 Nov;60(5):390–396. doi: 10.1136/hrt.60.5.390. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. McKeigue P. M., Miller G. J., Marmot M. G. Coronary heart disease in south Asians overseas: a review. J Clin Epidemiol. 1989;42(7):597–609. doi: 10.1016/0895-4356(89)90002-4. [DOI] [PubMed] [Google Scholar]
  17. McKeigue P. M., Shah B., Marmot M. G. Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians. Lancet. 1991 Feb 16;337(8738):382–386. doi: 10.1016/0140-6736(91)91164-p. [DOI] [PubMed] [Google Scholar]
  18. Olefsky J. M. The insulin receptor: its role in insulin resistance of obesity and diabetes. Diabetes. 1976 Dec;25(12):1154–1162. doi: 10.2337/diab.25.12.1154. [DOI] [PubMed] [Google Scholar]
  19. Pfeifle B., Ditschuneit H. Effect of insulin on growth of cultured human arterial smooth muscle cells. Diabetologia. 1981 Feb;20(2):155–158. doi: 10.1007/BF00262020. [DOI] [PubMed] [Google Scholar]
  20. Stern M. P., Haffner S. M. Body fat distribution and hyperinsulinemia as risk factors for diabetes and cardiovascular disease. Arteriosclerosis. 1986 Mar-Apr;6(2):123–130. doi: 10.1161/01.atv.6.2.123. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES