Skip to main content
Top
Published in: Current Diabetes Reports 10/2017

Open Access 01-10-2017 | Macrovascular Complications in Diabetes (VR Aroda and A Getaneh, Section Editors)

Cardiovascular and Mortality Risks in Migrant South Asians with Type 2 Diabetes: Are We Winning the Battle?

Authors: Emma Johns, Naveed Sattar

Published in: Current Diabetes Reports | Issue 10/2017

Login to get access

Abstract

Purpose of Review

We seek to describe the relationship between diabetes mellitus and cardiovascular risk in migrant South Asians compared to native white Europeans, and to determine the temporal change in this relationship over recent years.

Recent Findings

Recent evidence suggests that the excess mortality risk associated with diabetes is lower in the migrant South Asian population compared with white Europeans. By contrast, South Asians continue to demonstrate elevated cardiovascular morbidity compared to white Europeans, although to a lesser extent than was observed in previous decades.

Summary

The excess mortality previously observed in South Asian migrants has attenuated with a lower mortality risk compared to white Europeans observed in several recent studies. We speculate that these findings may relate in part to earlier diabetes diagnosis and more prolonged exposure to cardiovascular risk factor management in the South Asian population. Further study is required to confirm these hypotheses.
Literature
1.
go back to reference Sarwar N, Gao P, Seshasai S, Gobin R, Kaptoge S, Di Angelantonio E, et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet. 2010;375(9733):2215–22.CrossRefPubMed Sarwar N, Gao P, Seshasai S, Gobin R, Kaptoge S, Di Angelantonio E, et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet. 2010;375(9733):2215–22.CrossRefPubMed
2.
go back to reference Mather HM, Keen H. The Southall Diabetes Survey: prevalence of known diabetes in Asians and Europeans. Br Med J. 1985;291(6502):1081–4.CrossRef Mather HM, Keen H. The Southall Diabetes Survey: prevalence of known diabetes in Asians and Europeans. Br Med J. 1985;291(6502):1081–4.CrossRef
3.
go back to reference Tillin T, Hughes AD, Mayet J, Whincup P, Sattar N, Forouhi NG, et al. The relationship between metabolic risk factors and incident cardiovascular disease in Europeans, South Asians, and African Caribbeans: SABRE (Southall and Brent revisited)—a prospective population-based study. J Am Coll Cardiol. 2013;61(17):1777–86.CrossRefPubMedPubMedCentral Tillin T, Hughes AD, Mayet J, Whincup P, Sattar N, Forouhi NG, et al. The relationship between metabolic risk factors and incident cardiovascular disease in Europeans, South Asians, and African Caribbeans: SABRE (Southall and Brent revisited)—a prospective population-based study. J Am Coll Cardiol. 2013;61(17):1777–86.CrossRefPubMedPubMedCentral
4.
go back to reference Chaturvedi N, Fuller JH. Ethnic differences in mortality from cardiovascular disease in the UK: do they persist in people with diabetes? J Epidemiol Community Health. 1996;50(2):137–9.CrossRefPubMedPubMedCentral Chaturvedi N, Fuller JH. Ethnic differences in mortality from cardiovascular disease in the UK: do they persist in people with diabetes? J Epidemiol Community Health. 1996;50(2):137–9.CrossRefPubMedPubMedCentral
5.
go back to reference Shah BR, Victor JC, Chiu M, Tu JV, Anand SS, Austin PC, et al. Cardiovascular complications and mortality after diabetes diagnosis for South Asian and Chinese patients. Diabetes Care. 2013;36(9):2670–6.CrossRefPubMedPubMedCentral Shah BR, Victor JC, Chiu M, Tu JV, Anand SS, Austin PC, et al. Cardiovascular complications and mortality after diabetes diagnosis for South Asian and Chinese patients. Diabetes Care. 2013;36(9):2670–6.CrossRefPubMedPubMedCentral
6.
go back to reference •• Sattar N, Gill JMR. Type 2 diabetes in migrant south Asians: mechanisms, mitigation, and management. Lancet Diabetes Endocrinol. 2015;3(12):1004–16. A comprehensive review outlining the causes and consequences of the diabetes burden in migrant South Asians. Potential management strategies that are ethnically specific and key aims for future research are also discussed. •• Sattar N, Gill JMR. Type 2 diabetes in migrant south Asians: mechanisms, mitigation, and management. Lancet Diabetes Endocrinol. 2015;3(12):1004–16. A comprehensive review outlining the causes and consequences of the diabetes burden in migrant South Asians. Potential management strategies that are ethnically specific and key aims for future research are also discussed.
7.
go back to reference Ntuk UE, Gill JMR, Mackay DF, Sattar N, Pell JP. Ethnic-specific obesity cutoffs for diabetes risk: cross-sectional study of 490,288 UK biobank participants. Diabetes Care. 2014;37(9):2500–7.CrossRefPubMed Ntuk UE, Gill JMR, Mackay DF, Sattar N, Pell JP. Ethnic-specific obesity cutoffs for diabetes risk: cross-sectional study of 490,288 UK biobank participants. Diabetes Care. 2014;37(9):2500–7.CrossRefPubMed
8.
go back to reference Hippisley-Cox J, Coupland C, Robson J, Sheikh A, Brindle P. Predicting risk of type 2 diabetes in England and Wales: prospective derivation and validation of QDScore. BMJ. 2009;338:b880.CrossRefPubMedPubMedCentral Hippisley-Cox J, Coupland C, Robson J, Sheikh A, Brindle P. Predicting risk of type 2 diabetes in England and Wales: prospective derivation and validation of QDScore. BMJ. 2009;338:b880.CrossRefPubMedPubMedCentral
9.
go back to reference Sproston K, Mindell J. The health of minority ethnic groups, Health Survey for England-2004, vol. vol 1. Leeds: The Information Centre; 2006. Sproston K, Mindell J. The health of minority ethnic groups, Health Survey for England-2004, vol. vol 1. Leeds: The Information Centre; 2006.
10.
go back to reference Nakagami T, Qiao Q, Carstensen B, Nhr-Hansen C, Hu G, Tuomilehto J, et al. Age, body mass index and type 2 diabetes-associations modified by ethnicity. Diabetologia. 2003;46(8):1063–70.CrossRefPubMed Nakagami T, Qiao Q, Carstensen B, Nhr-Hansen C, Hu G, Tuomilehto J, et al. Age, body mass index and type 2 diabetes-associations modified by ethnicity. Diabetologia. 2003;46(8):1063–70.CrossRefPubMed
11.
go back to reference Mather HM, Chaturvedi N, Fuller JH. Mortality and morbidity from diabetes in South Asians and Europeans: 11-year follow-up of the Southall Diabetes Survey, London, UK. Diabet Med. 1998;15(1):53–9.CrossRefPubMed Mather HM, Chaturvedi N, Fuller JH. Mortality and morbidity from diabetes in South Asians and Europeans: 11-year follow-up of the Southall Diabetes Survey, London, UK. Diabet Med. 1998;15(1):53–9.CrossRefPubMed
12.
go back to reference Bellary S, Paul O’Hare J, Raymond NT, Mughal S, Hanif WM, Jones A, et al. Premature cardiovascular events and mortality in south Asians with type 2 diabetes in the United Kingdom Asian diabetes study—effect of ethnicity on risk. Curr Med Res Opin. 2010;26(8):1873–9.CrossRefPubMed Bellary S, Paul O’Hare J, Raymond NT, Mughal S, Hanif WM, Jones A, et al. Premature cardiovascular events and mortality in south Asians with type 2 diabetes in the United Kingdom Asian diabetes study—effect of ethnicity on risk. Curr Med Res Opin. 2010;26(8):1873–9.CrossRefPubMed
13.
go back to reference Health and Social Care Information Centre. National Diabetes Audit 2010–11, Report 2: complications and mortality. Leeds: Healthcare Quality Improvement Partnership; 2012. Health and Social Care Information Centre. National Diabetes Audit 2010–11, Report 2: complications and mortality. Leeds: Healthcare Quality Improvement Partnership; 2012.
14.
go back to reference Khan NA, Wang H, Anand S, Jin Y, Campbell NRC, Pilote L, et al. Ethnicity and sex affect diabetes incidence and outcomes. Diabetes Care. 2011;34(1):96–101.CrossRefPubMed Khan NA, Wang H, Anand S, Jin Y, Campbell NRC, Pilote L, et al. Ethnicity and sex affect diabetes incidence and outcomes. Diabetes Care. 2011;34(1):96–101.CrossRefPubMed
15.
go back to reference Health and Social Care Information Centre. National Diabetes Audit 2011–2012, Report 2: complications and mortality. Leeds: Healthcare Quality Improvement Partnership; 2013. Health and Social Care Information Centre. National Diabetes Audit 2011–2012, Report 2: complications and mortality. Leeds: Healthcare Quality Improvement Partnership; 2013.
16.
go back to reference Health and Social Care Information Centre. National Diabetes Audit 2012–2013, Report 2: complications and mortality. Leeds: Healthcare Quality Improvement Partnership; 2015. Health and Social Care Information Centre. National Diabetes Audit 2012–2013, Report 2: complications and mortality. Leeds: Healthcare Quality Improvement Partnership; 2015.
17.
go back to reference •• Wright AK, Kontopantelis E, Emsley R, Buchan I, Sattar N, Rutter MK, et al. Life expectancy and cause-specific mortality in type 2 diabetes: a population-based cohort study quantifying relationships in ethnic subgroups. Diabetes Care. 2017;40(3):338–45. This retrospective cohort study examines the relationship between ethnicity, life expectancy and cause-specific mortality. It provides novel evidence that the years of life lost in association with diabetes relative to non-diabetes are fewer in South Asians compared with white Europeans. Surprisingly, diabetes was also associated with a small increase in life expectancy compared to non-diabetics in the elderly South Asian population. •• Wright AK, Kontopantelis E, Emsley R, Buchan I, Sattar N, Rutter MK, et al. Life expectancy and cause-specific mortality in type 2 diabetes: a population-based cohort study quantifying relationships in ethnic subgroups. Diabetes Care. 2017;40(3):338–45. This retrospective cohort study examines the relationship between ethnicity, life expectancy and cause-specific mortality. It provides novel evidence that the years of life lost in association with diabetes relative to non-diabetes are fewer in South Asians compared with white Europeans. Surprisingly, diabetes was also associated with a small increase in life expectancy compared to non-diabetics in the elderly South Asian population.
18.
go back to reference Emerging Risk Factors Collaboration, Seshasai SRK, Kaptoge S, Thompson A, Di Angelantonio E, Gao P, et al. Diabetes mellitus, fasting glucose, and risk of cause-specific death. N Engl J Med. 2011;364(9):829–41.CrossRef Emerging Risk Factors Collaboration, Seshasai SRK, Kaptoge S, Thompson A, Di Angelantonio E, Gao P, et al. Diabetes mellitus, fasting glucose, and risk of cause-specific death. N Engl J Med. 2011;364(9):829–41.CrossRef
19.
go back to reference Gupta M, Martineau P, Tran T, Després J-P, Gaw A, de Teresa E, et al. Low-density lipoprotein cholesterol and high-sensitivity C-reactive protein lowering with atorvastatin in patients of South Asian compared with European origin: insights from the achieve cholesterol targets fast with atorvastatin stratified titration. J Clin Pharmacol. 2012 Jun;52(6):850–8.CrossRefPubMed Gupta M, Martineau P, Tran T, Després J-P, Gaw A, de Teresa E, et al. Low-density lipoprotein cholesterol and high-sensitivity C-reactive protein lowering with atorvastatin in patients of South Asian compared with European origin: insights from the achieve cholesterol targets fast with atorvastatin stratified titration. J Clin Pharmacol. 2012 Jun;52(6):850–8.CrossRefPubMed
20.
go back to reference Negandhi PH, Ghouri N, Colhoun HM, Fischbacher CM, Lindsay RS, McKnight JA, et al. Ethnic differences in glycaemic control in people with type 2 diabetes mellitus living in Scotland. PLoS One. 2013;8(12):e83292.CrossRefPubMedPubMedCentral Negandhi PH, Ghouri N, Colhoun HM, Fischbacher CM, Lindsay RS, McKnight JA, et al. Ethnic differences in glycaemic control in people with type 2 diabetes mellitus living in Scotland. PLoS One. 2013;8(12):e83292.CrossRefPubMedPubMedCentral
21.
go back to reference Misra A, Tandon N, Ebrahim S, Sattar N, Alam D, Shrivastava U, et al. Diabetes, cardiovascular disease, and chronic kidney disease in South Asia: current status and future directions. BMJ. 2017;357:j1420.CrossRefPubMed Misra A, Tandon N, Ebrahim S, Sattar N, Alam D, Shrivastava U, et al. Diabetes, cardiovascular disease, and chronic kidney disease in South Asia: current status and future directions. BMJ. 2017;357:j1420.CrossRefPubMed
Metadata
Title
Cardiovascular and Mortality Risks in Migrant South Asians with Type 2 Diabetes: Are We Winning the Battle?
Authors
Emma Johns
Naveed Sattar
Publication date
01-10-2017
Publisher
Springer US
Published in
Current Diabetes Reports / Issue 10/2017
Print ISSN: 1534-4827
Electronic ISSN: 1539-0829
DOI
https://doi.org/10.1007/s11892-017-0929-5

Other articles of this Issue 10/2017

Current Diabetes Reports 10/2017 Go to the issue

Microvascular Complications—Retinopathy (JK Sun and PS Silva, Section Editors)

Screening Intervals for Diabetic Retinopathy and Implications for Care

Microvascular Complications—Retinopathy (JK Sun and PS Silva, Section Editors)

Intraocular Inflammation in Diabetic Populations

Therapies and New Technologies in the Treatment of Type 1 Diabetes (M Pietropaolo, Section Editor)

Management of Type 1 Diabetes in the Hospital Setting

Microvascular Complications—Retinopathy (JK Sun and PS Silva, Section Editors)

Diameter Changes of Retinal Vessels in Diabetic Retinopathy

Immunology, Transplantation, and Regenerative Medicine (L Piemonti and V Sordi, Section Editors)

Heterogeneity in the Beta-Cell Population: a Guided Search Into Its Significance in Pancreas and in Implants

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.