Ethnic minorities have specific needs with regard to cardiovascular risk

Editor—The identification of patients at high risk of coronary heart disease is vital for preventive clinical care.¹,² Robson et al state that a reduction of absolute cardiovascular risk in the tenth of the population with coronary risk ⩾30% is likely to be cost beneficial.³ South Asians and Afro-Caribbeans in the United Kingdom are at increased risk of coronary heart disease and stroke, respectively, compared with people of European ethnicity. Most of the United Kingdom populations studied for assessment of cardiovascular risk have not, however, been stratified by ethnic group, and little research has been conducted into factors affecting uptake of preventive care in such patients.

We recently performed a pilot study of assessment of cardiovascular risk factors in south Asian and Afro-Caribbean patients aged 16-79 attending one south London practice.⁴ We found that half had at least two risk factors for cardiovascular disease. Women were less likely than men to be smokers (relative risk 0.4; 95% confidence interval 0.2 to 0.8) but more likely to take little or no exercise (1.7; 1.1 to 2.5). Focus groups suggested that barriers to effective health promotion included lack of awareness of risk, language difficulties, and cultural and lifestyle differences.

Motivational state and lack of perceived or actual risk may also cause delays in seeking medical help even after risk factors have been identified. Another London based study found that hypertensive patients of Afro-Caribbean ethnicity were less likely to use antihypertensive drugs than were patients of European ethnicity.⁵ General practitioners and primary care groups determining local policies for coronary disease prevention need to be aware of the specific needs of ethnic minority groups.