Abstract
STUDY OBJECTIVE: To examine the hypothesis that the higher rates of coronary heart disease (CHD) in Indians (South Asians) compared with Malays and Chinese is at least partly explained by central obesity, insulin resistance, and syndrome X (including possible components). DESIGN: Cross sectional study of the general population. SETTING: Singapore. PARTICIPANTS: Random sample of 961 men and women (Indians, Malays, and Chinese) aged 30 to 69 years. MAIN RESULTS: Fasting serum insulin concentration was correlated directly and strongly with body mass index (BMI), waist-hip ratio (WHR), and abdominal diameter. The fasting insulin concentration was correlated inversely with HDL cholesterol and directly with the fasting triglyceride concentration, blood pressures, plasminogen activator inhibitor 1 (PAI-1), and tissue plasminogen activator (tPA), but it was not correlated with LDL cholesterol, apolipoproteins B and A1, lipoprotein(a), (Lp(a)), fibrinogen, factor VIIc, or prothrombin fragment (F)1 + 2. This indicates that the former but not the latter are part of syndrome X. While Malays had the highest BMI, Indians had a higher WHR (men 0.93 and women 0.84) than Malays (men 0.91 and women 0.82) and Chinese (men 0.91 and women 0.82). In addition, Indians had higher fasting insulin values and more glucose intolerance than Malays and Chinese. Indians had lower HDL cholesterol, and higher PAI-1, tPA, and Lp(a), but not higher LDL cholesterol, fasting triglyceride, blood pressures, fibrinogen, factor VIIc, or prothrombin F1 + 2. CONCLUSIONS: Indians are more prone than Malays or Chinese to central obesity with insulin resistance and glucose intolerance and there are no apparent environmental reasons for this in Singapore. As a consequence, Indians develop some but not all of the features of syndrome X. They also have higher Lp(a) values. All this puts Indians at increased risk of atherosclerosis and thrombosis and must be at least part of the explanation for their higher rates of CHD.
Full text
PDF





Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Després J. P., Lamarche B., Mauriège P., Cantin B., Dagenais G. R., Moorjani S., Lupien P. J. Hyperinsulinemia as an independent risk factor for ischemic heart disease. N Engl J Med. 1996 Apr 11;334(15):952–957. doi: 10.1056/NEJM199604113341504. [DOI] [PubMed] [Google Scholar]
- Dhawan J., Bray C. L., Warburton R., Ghambhir D. S., Morris J. Insulin resistance, high prevalence of diabetes, and cardiovascular risk in immigrant Asians. Genetic or environmental effect? Br Heart J. 1994 Nov;72(5):413–421. doi: 10.1136/hrt.72.5.413. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Enas E. A., Mehta J. Malignant coronary artery disease in young Asian Indians: thoughts on pathogenesis, prevention, and therapy. Coronary Artery Disease in Asian Indians (CADI) Study. Clin Cardiol. 1995 Mar;18(3):131–135. doi: 10.1002/clc.4960180305. [DOI] [PubMed] [Google Scholar]
- Fontbonne A. Why can high insulin levels indicate a risk for coronary heart disease? Diabetologia. 1994 Sep;37(9):953–955. doi: 10.1007/BF00400954. [DOI] [PubMed] [Google Scholar]
- Gupta S., de Belder A., Hughes L. O. Avoiding premature coronary deaths in Asians in Britain. BMJ. 1995 Oct 21;311(7012):1035–1036. doi: 10.1136/bmj.311.7012.1035. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hajjar K. A., Gavish D., Breslow J. L., Nachman R. L. Lipoprotein(a) modulation of endothelial cell surface fibrinolysis and its potential role in atherosclerosis. Nature. 1989 May 25;339(6222):303–305. doi: 10.1038/339303a0. [DOI] [PubMed] [Google Scholar]
- Hughes K., Yeo P. P., Lun K. C., Sothy S. P., Thai A. C., Wang K. W., Cheah J. S. Ischaemic heart disease and its risk factors in Singapore in comparison with other countries. Ann Acad Med Singapore. 1989 May;18(3):245–249. [PubMed] [Google Scholar]
- Hughes K., Yeo P. P., Lun K. C., Thai A. C., Sothy S. P., Wang K. W., Cheah J. S., Phoon W. O., Lim P. Cardiovascular diseases in Chinese, Malays, and Indians in Singapore. II. Differences in risk factor levels. J Epidemiol Community Health. 1990 Mar;44(1):29–35. doi: 10.1136/jech.44.1.29. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hughes K., Yeo P. P., Lun K. C., Thai A. C., Wang K. W., Cheah J. S. Alcohol consumption in Chinese, Malays and Indians in Singapore. Ann Acad Med Singapore. 1990 May;19(3):330–332. [PubMed] [Google Scholar]
- Hughes K., Yeo P. P., Lun K. C., Thai A. C., Wang K. W., Cheah J. S. Physical activity in Chinese, Malays and Indians in Singapore. Ann Acad Med Singapore. 1990 May;19(3):326–329. [PubMed] [Google Scholar]
- Juhan-Vague I., Thompson S. G., Jespersen J. Involvement of the hemostatic system in the insulin resistance syndrome. A study of 1500 patients with angina pectoris. The ECAT Angina Pectoris Study Group. Arterioscler Thromb. 1993 Dec;13(12):1865–1873. doi: 10.1161/01.atv.13.12.1865. [DOI] [PubMed] [Google Scholar]
- 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]
- Lee H. P., Seah C. S., Yik T. Y., Low L. P., Leong S. F., Wan S. H., Ku G., Goh E. H., Chng W. Y. An epidemiological survey of blood pressures in Singapore. J Chronic Dis. 1977 Dec;30(12):793–802. doi: 10.1016/0021-9681(77)90007-8. [DOI] [PubMed] [Google Scholar]
- Lindahl B., Asplund K., Eliasson M., Evrin P-E Insulin resistance syndrome and fibrinolytic activity: the northern Sweden MONICA study. Int J Epidemiol. 1996 Apr;25(2):291–299. doi: 10.1093/ije/25.2.291. [DOI] [PubMed] [Google Scholar]
- McKeigue P. M. Coronary heart disease in Indians, Pakistanis, and Bangladeshis: aetiology and possibilities for prevention. Br Heart J. 1992 May;67(5):341–342. doi: 10.1136/hrt.67.5.341. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Miller G. J., Kotecha S., Wilkinson W. H., Wilkes H., Stirling Y., Sanders T. A., Broadhurst A., Allison J., Meade T. W. Dietary and other characteristics relevant for coronary heart disease in men of Indian, West Indian and European descent in London. Atherosclerosis. 1988 Mar;70(1-2):63–72. doi: 10.1016/0021-9150(88)90100-1. [DOI] [PubMed] [Google Scholar]
- Nordøy A. Haemostatic factors in coronary heart disease. J Intern Med. 1993 May;233(5):377–383. doi: 10.1111/j.1365-2796.1993.tb00688.x. [DOI] [PubMed] [Google Scholar]
- Reaven G. M. Banting lecture 1988. Role of insulin resistance in human disease. Diabetes. 1988 Dec;37(12):1595–1607. doi: 10.2337/diab.37.12.1595. [DOI] [PubMed] [Google Scholar]
- Reaven G. M. Pathophysiology of insulin resistance in human disease. Physiol Rev. 1995 Jul;75(3):473–486. doi: 10.1152/physrev.1995.75.3.473. [DOI] [PubMed] [Google Scholar]
- Saha N. Serum high density lipoprotein cholesterol, apolipoprotein A-I, A-II and B levels in Singapore ethnic groups. Atherosclerosis. 1987 Nov;68(1-2):117–121. doi: 10.1016/0021-9150(87)90101-8. [DOI] [PubMed] [Google Scholar]
- Sandholzer C., Hallman D. M., Saha N., Sigurdsson G., Lackner C., Császár A., Boerwinkle E., Utermann G. Effects of the apolipoprotein(a) size polymorphism on the lipoprotein(a) concentration in 7 ethnic groups. Hum Genet. 1991 Apr;86(6):607–614. doi: 10.1007/BF00201550. [DOI] [PubMed] [Google Scholar]
- Scanu A. M., Lawn R. M., Berg K. Lipoprotein(a) and atherosclerosis. Ann Intern Med. 1991 Aug 1;115(3):209–218. doi: 10.7326/0003-4819-115-3-209. [DOI] [PubMed] [Google Scholar]
- 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]
- Sériès F., Marc I. Influence of lung volume dependence of upper airway resistance during continuous negative airway pressure. J Appl Physiol (1985) 1994 Aug;77(2):840–844. doi: 10.1152/jappl.1994.77.2.840. [DOI] [PubMed] [Google Scholar]
- Williams B. Insulin resistance: the shape of things to come. Lancet. 1994 Aug 20;344(8921):521–524. doi: 10.1016/s0140-6736(94)91904-6. [DOI] [PubMed] [Google Scholar]
- Wiman B. Plasminogen activator inhibitor 1 (PAI-1) in plasma: its role in thrombotic disease. Thromb Haemost. 1995 Jul;74(1):71–76. [PubMed] [Google Scholar]