In their discussion on risk factors and myocardial infarction in South Asians1 Milan Gupta and colleagues omit some important issues. Lipoprotein (a) and homocysteine levels, reported higher in South Asians2 and with multiplicative risk, may partly explain their excess cardiovascular disease (CVD).3 Although not measured in this study, these factors warrant discussion because of risk amplification of conventional risk factors, which has implications for care.
Excess premature CVD (men < 55 years, women < 65 years), a crucial feature of CVD in South Asians, with implications for screening, prevention and treatment, also merits discussion. Recognized across the South Asian diaspora,3 this was previously reported in South Asian men and women admitted with acute myocardial infarctions to a Toronto hospital from 1990–95.4,5 The expected 10-year delay in onset of heart disease in women was reduced for South Asian women to a mean of 4.2 years (median 2.0 years). Premature CVD should thus probably be specifically examined and reported in studies on South Asia.
Vivian S. Rambihar Cardiologist The Scarborough Hospital Toronto, Ont.
References
- 1.Gupta M, Doobay AV, Singh N, Anand SS, Raja F, Mawji F, et al. Risk factors, hospital management and outcomes after acute myocardial infarction in South Asian Canadians and matched control subjects. CMAJ 2002;166(6):717-22. [PMC free article] [PubMed]
- 2.Anand SS, Yusuf S, Vuksan V, Devanesen D, Teo KK, Montague PA, et al. Difference in risk factors, atherosclerosis, and cardiovascular disease between ethnic groups in Canada: the Study of Health Assessment and Risk in Ethnic Groups (SHARE). Lancet 2000;356:279-84. [DOI] [PubMed]
- 3.Rambihar VS. South Asian heart: preventing heart disease — from the heart to the edge of the diaspora. Toronto: Vashna; 1996.
- 4.Rambihar VS, Wilson JL, Jagdeo DG. Ethnic variation and coronary artery disease. Can J Cardiol 1997;13(Suppl B):241B.
- 5.Rambihar SP, Rambihar V, Wilson J, Jagdeo DG, Vali Y, Chung W. Women, ethnic variation and CAD. Can J Cardiol 2000;16(Suppl B):49B.10653934