Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review
  • Published:

Ethnicity and cardiovascular disease prevention in the United Kingdom: a practical approach to management

Journal of Human Hypertension volume 21, pages 183–211 (2007)Cite this article

Abstract

The United Kingdom is a diverse society with 7.9% of the population from black and minority ethnic groups (BMEGs). The causes of the excess cardiovascular disease (CVD) and stroke morbidity and mortality in BMEGs are incompletely understood though socio-economic factors are important. However, the role of classical cardiovascular (CV) risk factors is clearly important despite the patterns of these risk factors varying significantly by ethnic group. Despite the major burden of CVD and stroke among BMEGs in the UK, the majority of the evidence on the management of such conditions has been based on predominantly white European populations. Moreover, the CV epidemiology of African Americans does not represent well the morbidity and mortality experience seen in black Africans and black Caribbeans, both in Britain and in their native African countries. In particular, atherosclerotic disease and coronary heart disease are still relatively rare in the latter groups. This is unlike the South Asian diaspora, who have prevalence rates of CVD in epidemic proportions both in the diaspora and on the subcontinent. As the BMEGs have been under-represented in research, a multitude of guidelines exists for the ‘general population.’ However, specific reference and recommendation on primary and secondary prevention guidelines in relation to ethnic groups is extremely limited. This document provides an overview of ethnicity and CVD in the United Kingdom, with management recommendations based on a roundtable discussion of a multidisciplinary ethnicity and CVD consensus group, all of whom have an academic interest and clinical practice in a multiethnic community.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Gill PS, Kai J, Bhopal RS, Wild S . Health care needs assessment: black and minority ethnic groups. In: Stevens A, Raftery J, Mant JM (eds). Health Care Needs Assessment. The epidemiologically based needs assessment reviews. Third Series. Radcliffe Medical Press: Oxford (http://hcna.radcliffe-oxford.com/bemgframe.htm).

  2. Bhopal R . Glossary of terms relating to ethnicity and race: for reflection and debate. J Epidemiol Community Health 2004; 58: 441–445.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Mckenzie KJ, Crowcroft NS . Describing race, ethnicity, and culture in medical research. BMJ 1996; 312(7038): 1054.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Williams R, Harding S . Poverty, stress and racism as factors in South Asian heart disease. In: Patel KCR, Bhopal RS (eds). The Epidemic of CHD in South Asian Populations: Causes and Consequences. South Asian Health Foundation, Birmingham 2003, pp. 135–143.

    Google Scholar 

  5. Senior PA, Bhopal R . Ethnicity as a variable in epidemiological research. BMJ 1994; 309(6950): 327–330.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Gill PS, Johnson M . Ethnic monitoring and ethnicity. BMJ 1995; 310(6984): 890.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Cappuccio FP . Epidemiologic transition, migration and CVD. Int J Epidemiol 2004; 33: 387–388.

    Article  PubMed  Google Scholar 

  8. Balarajan R . Ethnicity and variations in mortality from CHD. Health Trends 1996; 28: 45–51.

    Google Scholar 

  9. Raleigh VS, Kiri V, Balarajan R . Variations in mortality from diabetes mellitus, hypertension and renal disease in England and Wales by country of birth. Health Trends 1997; 28: 122–127.

    Google Scholar 

  10. UK Prospective Diabetes Study Group. UK Prospective Diabetes Study XII: Differences between Asian, AC and White European Caucasian type 2 diabetic patients at diagnosis of diabetes. Diabetic Med 1994; 11: 670–677.

  11. Wild S, McKeigue P . Cross sectional analysis of mortality by country of birth in England and Wales. 1970–92. BMJ 1997; 314: 705–710.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Liew R, Sulfi S, Ranjadayalan K, Cooper J, Timmis AD . Declining case fatality rates for acute myocardial infarction in South Asian and white patients in the past 15 years. Heart 2006; 92(8): 1030–1034.

    Article  CAS  PubMed  Google Scholar 

  13. Diabetes in the UK 2004. A report from Diabetes UK, October 2004. http://www.diabetes.org.uk/infocentre/reports/in_the_UK_2004.doc.Lastaccessed February 2006.

  14. Harland JO, Unwin N, Bhopal RS, White M, Watson B, Laker M et al. Low levels of CV risk factors and CHD in a UK Chinese population. J Epidemiol Community Health 1997; 6(51): 636–642.

    Article  Google Scholar 

  15. Bhopal R et al. Heterogeneity of coronary heart disease risk factors in Indian, Pakistani, Bangladeshi, and European origin populations: cross sectional study. BMJ 1999; 319(7204): 215–220.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Cappuccio FP, Cook DG, Atkinson RW, Wicks PD . The Wandsworth Heart and Stroke Study. A population-based survey of CV risk factors in different ethnic groups. Methods and baseline findings. Nutr Metab Cardiovasc Dis 1998; 8: 371–385.

    Google Scholar 

  17. Nazroo JY . The Health of Britain's Ethnic Minorities. Policy Studies Institute: London, 1997.

    Google Scholar 

  18. Yusuf S, Hawken S, Ôunpuu S, Bautista L, Franzosi MG, Commerford P et al. Obesity and the risk of myocardial infarction in 27 000 participants from 52 countries: a case-control study. Lancet 2005; 366: 1640–1649.

    Article  PubMed  Google Scholar 

  19. Wendler D, Kington R, Madans J, Van Wye G, Christ-Schmidt H, Pratt LA . Are racial and ethnic minorities less willing to participate in health research? PLoS Med 2006; 3: e19.

    Article  PubMed  Google Scholar 

  20. Anderson KM, Odell PM, Wislon PW, Kannell WB . Cardiovascular disease risk profiles. Am Heart J 1991; 121: 293–298.

    Article  CAS  PubMed  Google Scholar 

  21. De Backer G, Ambrosioni E, Borch-Johnsen K, Brotons C, Cifkova R, Dallongeville J et al. European guidelines on CVD prevention in clinical practice. Third Joint Task Force of European and other societies on CVD prevention in clinical practice. Eur Heart J 2003; 24: 1601–1610.

    Article  PubMed  Google Scholar 

  22. Bhopal R, Fischbacher C, Vartiainen E, Unwin N, White European M, Alberti G . Predicted and observed CVD in South Asians: application of FINRISK, Framingham and SCORE models to Newcastle Heart Project data. J Public Health 2005; 27(1): 93–100.

    Article  Google Scholar 

  23. Conroy RM, Pyorala K, Fitzgerald AP, Sans S, Menotti A, De Backer G, et al., SCORE project group. Estimation of ten-year risk of fatal CVD in Europe: the SCORE project. Eur Heart J 2003; 24: 987–1003.

    Article  CAS  PubMed  Google Scholar 

  24. Brindle P, May M, Gill PS, Cappuccio F, D’Agostino Sr R, Fischbacher C et al. Primary prevention of cardiovascular disease: a web-based risk score for seven british black and minority ethnic groups. Heart 2006 8 June; (E-pub ahead of print).

  25. JBSG: Joint British Societies Guidelines in Prevention of CVD in Clinical Practice. Heart 2005; 91(Suppl 5): V1–V52.

  26. Arabi M, Jackson P . Predicting risk in UK South Asians: an adjustment method for Framingham-based tools. Eur J Cardiovasc Prev Rehabil 2005; 12: 46–51.

    Article  Google Scholar 

  27. Patel KCR, Shah AM . Prevention, treatment and rehabilitation of CHD in south Asians. The Stationary Office 2006, ISBN 0-11-703608-0.

  28. Croxson SCM, Thomas P . Glucose tolerance tests reappraised using recent ADA criteria. Pract Diabetes Int 1998; 15: 178–180.

    Article  Google Scholar 

  29. Davies MJ, Muehlbayer S, Garrick P, McNally PG . Potential impact of a change in the diagnostic criteria for diabetes mellitus on the prevalence of abnormal glucose tolerance in a local community at risk of diabetes: impact of new diagnostic criteria for diabetes mellitus. Diabetic Med 1999; 16: 343–346.

    Article  CAS  PubMed  Google Scholar 

  30. Pan XR, Li GW, Hu YH, Wang JX, Yang WY, An ZX et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and diabetes study. Diabetes Care 1997; 20: 537–544.

    Article  CAS  PubMed  Google Scholar 

  31. Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P, et al., Finnish Diabetes Prevention Study Group. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001; 344: 1343–1350.

    Article  CAS  PubMed  Google Scholar 

  32. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al., Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346: 393–403.

    Article  CAS  PubMed  Google Scholar 

  33. Bhopal R . What is the risk of coronary heart disease in South Asians? A review of UK research. JPHM 2000; 22: 375–385.

    CAS  Google Scholar 

  34. De Backer G, Ambrosioni E, Borch-Johnsen K, Brotons C, Cifkova R, Dallongeville J, et al., Third Joint Force of European and other Societies on CVD and Prevention in Clinical Practice. European guidelines on CVD and prevention in clinical practice. Atherosclerosis 2004; 173(2): 381–391.

    Article  PubMed  Google Scholar 

  35. Marshall T . Evaluating national guidelines for prevention of cardiovascular disease in primary care. J Eval Clin Pract 2005; 11(5): 452–461.

    Article  PubMed  Google Scholar 

  36. Williams B, Poulter NR, Brown MJ, Davis M, McInnes GT, Potter JF, et al., British Hypertension Society Guidelines. Guidelines for the management of hypertension: report of the fourth working party of the British Hypertension Society, 2004 – BHS IV. J Hum Hypertens 2004; 18: 139–185.

    Article  CAS  PubMed  Google Scholar 

  37. Ramsay LE, Williams B, Johnston GD, MacGregor GA, Poston L, Potter JF et al. Guidelines for management of hypertension: report of the third working party of the British Hypertension Society. J Hum Hypert 1999; 13: 569–592.

    Article  CAS  Google Scholar 

  38. Quirke T, Gill P, Mant J, Allan T . The applicability of the Framingham CHD prediction function to black and minority ethnic groups in the UK. Heart 2003; 89: 785–786.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Lancaster T, Stead LF . Individual behavioural counselling for smoking cessation. Cochrane Database Syst Rev. 2005, Issue 2. Art. No.: CD001292.pub2. DOI: 10.1002/14651858.CD001292.pub2.

  40. Henningfield JE, Fant RV, Buchhalter AR, Stitzer ML . Pharmacotherapy for nicotine dependence. CA Cancer J Clin 2005; 55: 281–299.

    Article  PubMed  Google Scholar 

  41. Hughes JR, Stead LF, Lancaster T . Nortriptyline for smoking cessation: a review. Nicotine Tob Res 2005; 7: 491–499.

    Article  CAS  PubMed  Google Scholar 

  42. Matthews G Khush Dil south Asian project: summary report 2005. http://www.nhslothian.scot.nhs.uk/publications/khushdil/summary.pdf.

  43. Matthews G . Mobilising communities: the Khush Dill experience. In: Patel K, Shah A (eds). Prevention, Treatment and Rehabilitation of CVD in South Asians. The Stationary Office: London, 2005, pp 83–95.

    Google Scholar 

  44. Crosier A, McNeill A . Mapping black and minority ethnic tobacco prevention resources. Department of Health, UK. 2003. http://www.dh.gov.uk/assetRoot/04/08/08/85/04080885.pdf.

  45. National Institute for Health & Clinical Excellence. Brief interventions and referral for smoking cessation in primary care and other settings. Public Health Intervention Guidance no.1. March 2006.

  46. Cappuccio FP, Cook DG, Atkinson RW, Strazzullo P . Prevalence, detection and management of cardiovascular risk factors in different ethnic groups in South London. Heart 1997; 78: 555–563.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Primatesta P, Bost L, Poulter NR . Blood pressure levels and hypertension status among ethnic groups in England. J Hum Hypertens 2000; 14: 143–148.

    Article  CAS  PubMed  Google Scholar 

  48. Agyemang C, Bhopal R . Is the blood pressure of people from African origin adults in the UK higher or lower than that in European origin white people? A review of cross-sectional data. J Hum Hypertens 2003; 17(8): 523–534.

    Article  PubMed  Google Scholar 

  49. Raleigh VS, Kiri V, Balarajan R . Variations in mortality from diabetes mellitus, hypertension and renal disease in England and Wales by country of birth. Health Trends 1996; 28(4): 12–122.

    Google Scholar 

  50. Cooper RS, Rotimi C, Ataman S, McGee D, Osotomehin B, Kadiri S et al. The prevalence of hypertension in seven populations of West African origin. Am J Public Health 1997; 87: 160–168.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Cappuccio FP, Micah FB, Emmett L, Kerry SM, Antwi S, Martin-Peprah R et al. Prevalence, detection, management and control of hypertension in Ashanti, West Africa. Hypertension 2004; 5(43): 1017–1022.

    Article  CAS  Google Scholar 

  52. Kaufman JS, Rotimi CN, Brieger WR, Oladokum MA, Kadiri S, Osotimehin BO et al. The mortality risk associated with hypertension: preliminary results of a prospective study in rural Nigeria. J Hum Hypertens 1996; 10(7): 461–464.

    CAS  PubMed  Google Scholar 

  53. Plange-Rhule J, Phillips R, Acheampong JW, Saggar-Malik AK, Cappuccio FP, Eastwood JB . Hypertension and renal failure in Kumasi, Ghana. J Hum Hypertens 1999; 13: 37–40.

    Article  CAS  PubMed  Google Scholar 

  54. Cappuccio FP, Cook DG, Atkinson RW, Strazzullo P . Prevalence, detection and management of cardiovascular risk factors in different ethnic groups in South London. Heart 1997; 78: 555–563.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Primatesta P, Bost L, Poulter NR . Blood pressure levels and hypertension status among ethnic groups in England. J Hum Hypertens 2000; 14: 143–148.

    Article  CAS  PubMed  Google Scholar 

  56. Gupta R, al Odat NA, Gupta VP . Hypertension epidemiology in India: meta-analysis of 50 year prevalence rates and blood pressure trends. J Hum Hypertens 1996; 10(7): 465–472.

    CAS  PubMed  Google Scholar 

  57. Gupta R, Sharma AK . Prevalence of hypertension and subtypes in an Indian rural population: clinical and electrocardiographic correlates. J Hum Hypertens 1994; 8(11): 823–829.

    CAS  PubMed  Google Scholar 

  58. Agyemang C, Bhopal RS . Is the blood pressure of South Asian adults in the UK higher or lower than that in European white adults? A review of cross-sectional data. J Hum Hypertens 2002; 16: 739–751.

    Article  CAS  PubMed  Google Scholar 

  59. Ramaiya KL, Swai AB, McLarty DG, Bhopal RS, Alberti KGMM . Prevalences of diabetes and cardiovascular disease risk factors in Hindu Indian subcommunities in Tanzania. Br Med J 1991; 303: 271–276.

    Article  CAS  Google Scholar 

  60. Balarajan R . Ethnic differences in mortality from ischaemic heart disease and cerebrovascular disease in England and Wales. Br Med J 1991; 302: 560–564.

    Article  CAS  Google Scholar 

  61. Primatesta P, Brookes M, Poulter NR . Improved hypertension management and control. Results from the Health Survey for England 1998. Hypertension 2001; 38: 827–832.

    Article  CAS  PubMed  Google Scholar 

  62. Du X, Cruickshank JK, McNamee R, Saraee M, Sourbutts J, Summers A et al. Case-control study of stroke and the quality of hypertension control in Northwest England. Br Med J 1997; 314: 272–276.

    Article  CAS  Google Scholar 

  63. Cappuccio FP, Siani A . Non-pharmacologic treatment of hypertension. In: Crawford MH, Di Marco JP (eds). International Textbook of Cardiology. Mosby International: London Edinburgh New York Philadelphia St Louis Sydney Toronto, 2001, pp 7.1–7.10.

    Google Scholar 

  64. He FJ, Markandu ND, Sagnella GA, MacGregor GA . Importance of the renin system in determining blood pressure fall with salt restriction in black and white hypertensives. Hypertension 1998; 32(5): 820–824.

    Article  CAS  PubMed  Google Scholar 

  65. Bray GA, Vollmer WM, Sacks FM, Obarzanek E, Svetkey LP, Appel LJ . A further subgroup analysis of the effects of the DASH diet and three dietary sodium levels on blood pressure: results of the DASH-Sodium Trial. Am J Cardiol 2004; 94(2): 222–227.

    Article  CAS  PubMed  Google Scholar 

  66. Cappuccio FP, Kerry SM, Micah FB, Plange-Rhule J, Eastwood JB . A community programme to reduce salt intake and blood pressure in Ghana (ISRCTN 88789643). BMC Public Health 2006; 6(1): 13.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Brewster LM, van Montfrans GA, Kleijnen J . Systematic review: antihypertensive drug therapy in black patients. Ann Intern Med 2004; 141(8): 614–627.

    Article  PubMed  Google Scholar 

  68. ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002; 288(23): 2981–2997.

  69. Patel JKV, Leaback R . Patients of Southern Asian descent treated with valsartan (POSATIV) study. Br J Cardiol 2002; 9(6): 351–354.

    Google Scholar 

  70. National Institute for Clinical Excellence. Management of Type 2 Diabetes – Management of Blood Pressure and Blood Lipids (Guideline H). NICE: London, 2002 (www.nice.org.uk).

  71. Materson BJ . Lessons on the interaction of race and antihypertensive drugs from the VA co-operative study group on antihypertensive agents. Am J Hypertens 1995; 8: 91S–93S.

    Article  CAS  PubMed  Google Scholar 

  72. Brown MJ . Hypertension and ethnic group. BMJ 2006; 332(7545): 833–836.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  73. Hu FB, Stampfer MJ, Haffner SM, Solomon CG, Willet WC, Manson JE . Elevated risk of cardiovascular disease prior to clinical diagnosis of type 2 diabetes. Diabetes Care 2002; 25: 1129–1134.

    Article  PubMed  Google Scholar 

  74. Haffner SM, Miettinen H . Insulin resistance implications for type II diabetes mellitus and coronary heart disease. Am J Med 1997; 103: 152–162.

    Article  CAS  PubMed  Google Scholar 

  75. Whitty CJM, Brunner EJ, Shipley MJ, Hemingway H, Marmot MG . Differences in biological risk factors for cardiovascular disease between three ethnic groups in the Whitehall II study. Atherosclerosis 1999; 142: 279–286.

    Article  CAS  PubMed  Google Scholar 

  76. Miller GJ, Beckles GLA, Alexis SD, Byam NTA, Price SGL . Serum lipoproteins and susceptibility of men of Indian descent to coronary heart disease: The St James Survey, Trinidad. Lancet 1982; 2(8291): 200–203.

    Article  CAS  PubMed  Google Scholar 

  77. Seedat YK, Mayet FGH, Khan S, Somers SR, Joubert G . Risk factors for coronary heart disease in the Indians of Durban. SA Med J 1990; 78: 447–454.

    CAS  Google Scholar 

  78. Bhatnagar D, Anand IS, Durrington PN, Patel DJ, Wander GS, Mackness MI et al. Coronary risk factors in people from the Indian subcontinent living in West London and their siblings in India. Lancet 1995; 345: 405–409.

    Article  CAS  PubMed  Google Scholar 

  79. Patel J, Vyas A, Cruickshank JK, Phrabharkaran D, Hughes EA, Mackness MI et al. Impact of migration or coronary heart disease risk factors: comparison of Gujratis in Britain and their contemporaries in villages of origin in India. Atherosclerosis 2006; 185: 297–306.

    Article  CAS  PubMed  Google Scholar 

  80. La Rosa JC, He J, Vupputuri S . Effect of statins on the risk of coronary heart disease: a meta-analysis of randomised controlled trials. JAMA 1999; 282: 2340–2346.

    Article  CAS  Google Scholar 

  81. Lamarche B, Tchernof A, Moorjani S, Cantin B, Dagenais GR, Lupien PJ et al. Small dense LDL particles and the risk of ischaemic heart disease: prospective results from the Québec Cardiovascular study. Circulation 1997; 95: 69–75.

    Article  CAS  PubMed  Google Scholar 

  82. Gordon T, Castelli WP, Hjortland MC, Kannel WB, Dawber TR . High density lipoprotein as a protective factor against coronary heart disease: The Framingham study. Am J Med 1977; 62: 707–714.

    Article  CAS  PubMed  Google Scholar 

  83. Cooper R, Sempos C, Ghall J, Ferlinz J . High density lipoprotein cholesterol and angiographic coronary artery disease in Black patients. Am Heart J 1985; 110: 1006–1011.

    Article  CAS  PubMed  Google Scholar 

  84. Thomas I, Gupta S, Sempos C, Cooper R . Serum lipids of Indian physicians living in the US compared to US-born physicians. Atherosclerosis 1986; 61: 99–106.

    Article  CAS  PubMed  Google Scholar 

  85. Srinivasan SR, Frerichs RR, Webber LS, Berenson GS . Serum lipoprotein profile in children from a biracial community. Circulation 1976; 54(2): 309–318.

    Article  CAS  PubMed  Google Scholar 

  86. Frerichs RR, Srinivasan SR, Webber LS, Berenson GR . Serum cholesterol and triglyceride levels in 3446 children from a biracial community. Circulation 1976; 54(2): 302–309.

    Article  CAS  PubMed  Google Scholar 

  87. Miller G, Becles GLA, Byam NT, Price SG, Carson DC, Kirkwood BR et al. Serum lipoproteins concentration in relation to ethnic composition and urbanization in men and women of Trinidad West Indies. Int J Epidemiol 1984; 13: 413–421.

    Article  CAS  PubMed  Google Scholar 

  88. Chaturvedi N, McKeigue PM, Marmot MG . Relationship of glucose intolerance to coronary risk in AfroCaribbeans compared with Europeans. Diabetologia 1994; 37: 765–772.

    Article  CAS  PubMed  Google Scholar 

  89. Miller GJ, Kotecha S, Wilkinson WH, Wilkes H, Stirling Y, Sanders TA et al. Dietary and other characteristics releavant for coronary heart disease in men of Indian, West Indian and European descent in London. Atherosclerosis 1988; 70: 63–72.

    Article  CAS  PubMed  Google Scholar 

  90. Li ZY, Xu GB, Xia TA . Prevalence rate of metabolic syndrome and dyslipidaemia in a large professional population in Beijing. Atherosclerosis 2006; 184(1): 188–192.

    Article  CAS  PubMed  Google Scholar 

  91. Zoratti R . A review on ethnic differences in plasma triglycerides and high density lipoprotein cholesterol: Is the lipid patten the key factor for the low coronary heart disase rate in people of African origin? Eur J Epidemiol 1998; 14: 9–21.

    Article  CAS  PubMed  Google Scholar 

  92. Tai ES, Emmanuel SC, Chen SK, Tan BY, Tan CE . Isolated low HDL cholesterol: an insulin resistant state only in the presence of fasting hypertriglyceridaemia. Diabetes 1999; 48: 1088–1092.

    Article  CAS  PubMed  Google Scholar 

  93. Miller M . Is hypertriglyceridaemia an independent risk factor for coronary heart disease? Eur Heart J 1998; 19: H18–H22.

    PubMed  Google Scholar 

  94. Hokanson JE, Austin MA . Plasma triglyceride level is a risk factor for cardiovascular disease independent of high-density lipoprotein cholesterol level: a meta analysis of population-based prospective studies. J Cardiovasc Risk 1996; 3: 213–299.

    Article  CAS  PubMed  Google Scholar 

  95. Anand SS, Enas EA, Pogue J, Haffner S, Pearson T, Yusuf S . Elevated Lipoprotein(a) levels in South Asians in North America. Metabolism 1998; 47: 182–184.

    Article  CAS  PubMed  Google Scholar 

  96. Dahlen GH, Stenlund H . Lp (a) lipoprotein is a major risk factor for cardiovascular disease: pathogenic mechanisms and clinical significance. Clin Genet 1997; 52: 272–280.

    Article  CAS  PubMed  Google Scholar 

  97. Dieplinger H, Utermann G . The seventh myth of lipoprotein (a): where and how is it assembled? Curr Opin Lipidol 1999; 10: 275–283.

    Article  CAS  PubMed  Google Scholar 

  98. Sacks FM, Tonkin AM, Shepherd J, Braunwald E, Cobbe S, Hawkins CM et al. Effect of pravastatin on coronary disease events in subgroups defined bycoronary risk factors: the Prospective Pravastatin Pooling Project. Circulation 2000; 102: 1893–1900.

    Article  CAS  PubMed  Google Scholar 

  99. Patel MG, Wright DJ, Gill PS, Jerwood D, Silcock J, Chrystyn H . Prescribing of lipid lowering drugs to South Asian patients: ecological study. BMJ 2002; 325: 25–26.

    Article  PubMed  PubMed Central  Google Scholar 

  100. Rubins HB, Robins SJ, Collins D, Fye CL, Anderson JW, Elam MB, et al., for the Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial Study Group. Gemfibrozil for the secondary prevention of CHD in men with low levels of high-density lipoprotein cholesterol. N Engl J Med 1999; 341: 410–418.

    Article  CAS  PubMed  Google Scholar 

  101. FIELD Study Investigators. Effects of long-term fenofibrate therapy on CV events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. Lancet 2005; 366: 1849–1861.

  102. Grundy SM, Vega GL, McGovern ME, Tulloch BR, Kendall DM, Fitz-Patrick D et al. Efficacy, safety and tolerability of once-daily niacin for the treatment of dyslipidaemia associated with type 2 diabetes. Arch Intern Med 2002; 162: 1568–1576.

    Article  CAS  PubMed  Google Scholar 

  103. Guyton JR, Blazing MA, Hagar J, Kashyap ML, Knopp RH, McKenney JM et al. Extended-release niacin vs gemfibrozil for the treatment of low levels of high-density lipoprotein cholesterol. Arch Intern Med 2000; 160: 1177–1184.

    Article  CAS  PubMed  Google Scholar 

  104. Health Survey for England. The health of minority ethnic groups 99. The Stationery office: London, 2001.

  105. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002; 106: 3143–3421.

  106. International Diabetes Federation. The IDF consensus worldwide definition of the metabolic syndrome. Retrieved February 2006, from http://www.idf.org.

  107. Kooner JS, Bliga RR, Wilding J, Crook D, Packard CJ, Banks LM et al. Abdominal obesity, impaired nonesterified fatty acid suppression, and insulin-mediated glucose disposal are early metabolic abnormalities in families with premature myocardial infarction. Arterioscler Thromb Vasc Biol 1998; 18: 1021–1026.

    Article  CAS  PubMed  Google Scholar 

  108. Zoratti R, Godsland IF, Chaturvedi N, Crook D, Stevenson JC, McKeigue PM . Relation of plasma lipids to insulin resistance, nonesterified fatty acid levels, and body fat in men from three ethnic groups: relevance to variation in risk of diabetes and coronary heart disease. Metabolism 2000; 49: 245–252.

    Article  CAS  PubMed  Google Scholar 

  109. Heart Outcomes Prevention Evaluation Study Investigators. Effects of ramipril on CV and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE sub-study. Lancet 2000; 355: 253–259.

  110. Daly CA, Fox KM, Remme WJ, Bertrand ME, Ferrari R, Simoons ML et al. The effects of perindopril on CV morbidity and mortality in patients with diabetes in the EUROPA study: results from the PERSUADE substudy. Eur Heart J 2005; 26: 1369–1378.

    Article  CAS  PubMed  Google Scholar 

  111. The EURopean trial On reduction of cardiac events with Perindopril in stable CHD investigators. Efficacy of perindopril in reduction of CV events among patients with stable CHD: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study). Lancet 2003; 362: 782–788.

  112. Lindholm LH, Ibsen H, Dahlöf B, Devereux RB, Beevers G, de Faire U et al. CV morbidity and mortality in patients with diabetes in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002; 359: 1004–1010.

    Article  CAS  PubMed  Google Scholar 

  113. Deferrari G, Ravera M, Berruti V, Leoncini G, Deferrari L . Optimizing therapy in the diabetic patient with renal disease: antihypertensive treatment. J Am Soc Nephrol 2004; 15: S6–S11.

    Article  CAS  PubMed  Google Scholar 

  114. Parving HH, Lehenert H, Brochner-Mortensen J, Gomis R, Andersen S, Amer P, Irbesartan in patients with type 2 diabetes and microalbuminuria Study Group. The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. N Engl J Med 2001; 345: 870–878.

    Article  CAS  PubMed  Google Scholar 

  115. Brenner BM, Cooper ME, de Zeeuw D, Keane WF, Mitch WE, Parving HH, et al., RENAAL Study Investigators. Effects of losartan on renal and CV outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med 2001; 345: 861–869.

    Article  CAS  PubMed  Google Scholar 

  116. Lewis EJ, Hunsicker LG, Clarke WR, Berl T, Pohl MA, Lewis JB, et al., Collaborative Study Group. Renoprotective effect of the angiotensin receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med 2001; 345: 851–860.

    Article  CAS  PubMed  Google Scholar 

  117. Barnett AH, Bain SC, Bouter P, Karlberg B, Madsbad S, Jervell J, et al., Diabetics Exposed to Telmisartan and Enalapril Study Group. Angiotensin-receptor blockade versus converting-enzyme inhibition in type 2 diabetes and nephropathy. N Engl J Med 2004; 351: 1952–1961.

    Article  CAS  PubMed  Google Scholar 

  118. Dahlöf B, Sever P, Poulter N, Wedel H, Beevers DG, Caulfield M et al. Prevention of CV events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomized controlled trial. Lancet 2005; 366: 895–906.

    Article  CAS  PubMed  Google Scholar 

  119. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial. Lancet 2003; 361: 2005–2016.

  120. Colhoun HM, Betteridge DJ, Durrington PN, Hitman GA, Neil HA, Livingstone SJ et al. Primary prevention of CVD with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial. Lancet 2004; 364: 685–696.

    Article  CAS  PubMed  Google Scholar 

  121. Antithrombotic Trialists’ Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002; 324: 71–86.

  122. Hansson L, Zanchetti A, Carruthers SG, Dahlöf B, Elmfeldt D, Julius S et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet 1998; 351: 1755–1762.

    Article  CAS  PubMed  Google Scholar 

  123. Meade TW, Brennan PJ, on behalf of the MRC General Practice Research Framework. Determination of who may derive most benefit from aspirin in primary prevention: subgroup results from a randomised controlled trial. BMJ 2000; 321: 13–17.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  124. Vaccarino V, Rathore SS, Wenger NK, Frederick PD, Abramson JL, Barron HV, et al., National Registry of Myocardial Infarction Investigators. Sex and racial differences in the management of acute myocardial infarction, 1994 through 2002. N Engl J Med 2005; 353(7): 671–682.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  125. Iribarren C, Tolstykh I, Somkin CP, Ackerson LM, Brown TT, Scheffler R et al. Sex and racial/ethnic disparities in outcomes after acute myocardial infarction: a cohort study among members of a large integrated health care delivery system in northern California. Arch Intern Med 2005; 165(18): 2105–2113.

    Article  PubMed  Google Scholar 

  126. Johnson PA, Lee TH, Cook EF, Rouan GW, Goldman L . Effect of race on the presentation and management of patients with acute chest pain. Ann Intern Med 1993; 118(8): 593–601.

    Article  CAS  PubMed  Google Scholar 

  127. Bradley EH, Herrin J, Wang Y, McNamara RL, Webster TR, Magid DJ et al. Racial and ethnic differences in time to acute reperfusion therapy for patients hospitalized with myocardial infarction. JAMA 2004; 292(13): 1563–1572.

    Article  CAS  PubMed  Google Scholar 

  128. Wilkinson P, Sayer J, Laji K, Grundy C, Marchant B, Kopelman P et al. Comparison of case fatality in south Asian and white patients after acute myocardial infarction: observational study. BMJ 1996; 312(7042): 1330–1333.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  129. Barakat K, Wells Z, Ramdhany S, Mills PG, Timmis AD . Bangladeshi patients present with non-classic features of acute myocardial infarction and are treated less aggressively in east London, UK. Heart 2003; 89(3): 276–279.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  130. Fischbacher CM, Bhopal R, Unwin N, White M, Alberti KG . The performance of the Rose angina questionnaire in South Asian and European origin populations: a comparative study in Newcastle, UK. Int J Epidemiol 2001; 30(5): 1009–1016.

    Article  CAS  PubMed  Google Scholar 

  131. Stewart A, Rao J, Osho-Williams G, Fairfield M, Ahmad R . Audit of primary care angina management in Sandwell, England. J R Soc Health 2002; 122(2): 112–117.

    Article  CAS  Google Scholar 

  132. Brown DW, Shepard D, Giles WH, Greenlund KJ, Croft JB . Racial differences in the use of aspirin: an important tool for preventing heart disease and stroke. Ethn Dis 2005 Autumn; 15(4): 620–626.

    PubMed  Google Scholar 

  133. Physicians’ Health Study Research Group. Final report on the aspirin component of the ongoing Physicians’ Health Study. N Engl J Med 1989; 321: 129–135.

  134. Baigent C, Collins R, Appleby P, Parish S, Sleight P, Peto R . ISIS-2: 10 year survival among patients with suspected acute myocardial infarction in randomised comparison of intravenous streptokinase, oral aspirin, both, or neither. The ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. BMJ 1998; 316(7141): 1337–1343.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  135. CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 1996; 348(9038): 1329–1339.

  136. Yusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognoni G, Fox KK, Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 2001; 345(7): 494–502.

    Article  CAS  PubMed  Google Scholar 

  137. Chen ZM, Jiang LX, Chen YP, Xie JX, Pan HC, Peto R, et al., COMMIT (ClOpidogrel and Metoprolol in Myocardial Infarction Trial) collaborative group. Addition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet 2005; 366: 1607–1621.

    Article  CAS  PubMed  Google Scholar 

  138. Mehta SR, Yusuf S, Peters RJ, Bertrand ME, Lewis BS, Natarajan MK, et al., Clopidogrel in Unstable angina to prevent Recurrent Events trial (CURE) Investigators. Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study. Lancet 2001; 358(9281): 527–533.

    Article  CAS  PubMed  Google Scholar 

  139. Freemantle N, Cleland J, Young P, Mason J, Harrison J . Beta blockade after myocardial infarction: systematic review and meta regression analysis. BMJ 1999; 318(7200): 1730–1737.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  140. Rodrigues EJ, Eisenberg MJ, Pilote L . Effects of early and late administration of angiotensin-converting enzyme inhibitors on mortality after myocardial infarction. Am J Med 2003; 115(6): 473–479.

    Article  CAS  PubMed  Google Scholar 

  141. Flather MD, Yusuf S, Kober L, Pfeffer M, Hall A, Murray G et al. Long-term ACE-inhibitor therapy in patients with heart failure or left-ventricular dysfunction: a systematic overview of data from individual patients. ACE-Inhibitor Myocardial Infarction Collaborative Group. Lancet 2000; 355(9215): 1575–1581.

    Article  CAS  PubMed  Google Scholar 

  142. Latini R, Tognoni G, Maggioni AP, Baigent C, Braunwald E, Chen ZM et al. Clinical effects of early angiotensin-converting enzyme inhibitor treatment for acute myocardial infarction are similar in the presence and absence of aspirin: systematic overview of individual data from 96,712 randomized patients. Angiotensin-converting Enzyme Inhibitor Myocardial Infarction Collaborative Group. J Am Coll Cardiol 2000; 35(7): 1801–1807.

    Article  CAS  PubMed  Google Scholar 

  143. Braunwald E, Domanski MJ, Fowler SE, Geller NL, Gersh BJ, Hsia J, et al., PEACE Trial Investigators. Angiotensin-converting-enzyme inhibition in stable coronary artery disease. N Engl J Med 2004; 351: 2058–2068.

    Article  CAS  PubMed  Google Scholar 

  144. Marchioli R, Barzi F, Bomba E, Chieffo C, Di Gregorio D, Di Mascio R, et al., GISSI-Prevenzione Investigators. Early protection against sudden death by n-3 polyunsaturated fatty acids after myocardial infarction: time-course analysis of the results of the Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico (GISSI)-Prevenzione. Circulation 2002; 105(16): 1897–1903.

    Article  CAS  PubMed  Google Scholar 

  145. GISSI Study Group. Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto miocardico. Lancet 1999; 354: 447–455.

  146. Lee KW, Lip GY . The role of omega-3 fatty acids in the secondary prevention of CVD. Q J Med 2003; 96(7): 465–480.

    Article  CAS  Google Scholar 

  147. Technology Appraisal No.47. Guidance on the use of glycoprotein IIb/IIIa inhibitors in the treatment of acute coronary syndromes. September 2002. National Institute of Clinical Excellence. www.nice.org.uk.

  148. PRISM Study Investigators. A comparison of aspirin plus tirofiban with aspirin plus heparin for unstable angina. Platelet Receptor Inhibition in Ischemic Syndrome Management. N Engl J Med 1998; 338(21): 1498–1505.

  149. Randomised placebo-controlled trial of abciximab before and during coronary intervention in refractory unstable angina: the CAPTURE Study. Lancet 1997; 349: 1429–1435.

  150. ESPRIT Investigators. Novel dosing regimen of eptifibatide in planned coronary stent implantation (ESPRIT): a randomised, placebo-controlled trial. Lancet 2000; 356: 2037–2204.

  151. Tan HC, Lim YT, Lim TT, Cheng A, Chia BL . The use of abciximab in coronary angioplasty – an Asian centre's experience. Singapore Med J 2000; 41(2): 69–73.

    CAS  PubMed  Google Scholar 

  152. Yeo KK, Beauvallet S, Mau MK, Seto TB . Procedural success and complications following percutaneous coronary interventions among Asians and Pacific Islanders. Clin Cardiol 2005; 28(9): 429–432.

    Article  PubMed  Google Scholar 

  153. Sane DC, Stump DC, Topol EJ, Sigmon KN, Clair WK, Kereiakes DJ et al. Racial differences in responses to thrombolytic therapy with recombinant tissue-type plasminogen activator. Increased fibrin(ogen)olysis in blacks. The Thrombolysis and Angioplasty in Myocardial Infarction Study Group. Circulation 1991; 83(1): 170–175.

    Article  CAS  PubMed  Google Scholar 

  154. Califf RM, Pieper KS, Lee KL, Van De Werf F, Simes RJ, Armstrong PW et al. Prediction of 1-year survival after thrombolysis for acute myocardial infarction in the global utilization of streptokinase and TPA for occluded coronary arteries trial. Circulation 2000; 101(19): 2231–2238.

    Article  CAS  PubMed  Google Scholar 

  155. Dhawan J, Bray C . Are Asian coronary arteries smaller than Caucasian? A study on angiographic coronary artery size estimation during life. Int J Cardiol 1995; 49(3): 267–269.

    Article  CAS  PubMed  Google Scholar 

  156. Lip GY, Rathore VS, Katira R, Watson RD, Singh SP . Do Indo-Asians have smaller coronary arteries? Postgrad Med J 1999; 75(886): 463–466.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  157. Britton A, Shipley M, Marmot M, Hemingway H . Does access to cardiac investigation and treatment contribute to social and ethnic differences in coronary heart disease? Whitehall II prospective cohort study. BMJ 2004; 329(7461): 318.

    Article  PubMed  PubMed Central  Google Scholar 

  158. Jones M, Ramsay J, Feder G, Crook AM, Hemingway H . Influence of practices’ ethnicity and deprivation on access to angiography: an ecological study. Br J Gen Pract 2004; 54(503): 423–428.

    PubMed  PubMed Central  Google Scholar 

  159. Hemingway H, Feder G, Crook AM, Magee P, Banerjee S, Timmis AD et al. Ethnic differences in invasive management of coronary disease: prospective cohort study of patients undergoing angiography. BMJ 2002; 324(7336): 511–516.

    Article  PubMed  PubMed Central  Google Scholar 

  160. Hobbs SD, Wilmink ABM, Bradbury AW . Ethnicity and peripheral arterial disease. Eur J Vasc Endovasc Surg 2003; 25: 505–512.

    Article  CAS  PubMed  Google Scholar 

  161. Kannel WB . The demographics of claudication and the aging of the American population. Vascular Med 1996; 1(1): 60–64.

    Article  CAS  Google Scholar 

  162. Murabito JM, D’Agostino RB, Silbershatz H, Wilson PWF . Intermittent claudication: a risk profile from the Framingham Heart Study. Circulation 1997; 96: 44–49.

    Article  CAS  PubMed  Google Scholar 

  163. Janka HU, Standl E, Mehnert H . Peripheral vascular disease in diabetes mellitus and its relation to cardiovascular risk factors: screening with Doppler ultrasonic technique. Diabetes Care 1980; 3: 207–213.

    Article  CAS  PubMed  Google Scholar 

  164. Fernando DJ, Siribaddana S, Perera N, Perera S, de Silva D . The prevalence of macrovascular disease and lipid abnormalities amongst diabetic patients in Sri Lanka. Postgrad Med J 1993; 69(813): 557–561.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  165. Mohan V, Premalatha G, Sastry NG . Peripheral vascular disease in non-insulin-dependent diabetes mellitus in south India. Diabetes Res Clin Pract 1995; 27(3): 235–240.

    Article  CAS  PubMed  Google Scholar 

  166. Fowkes FG, Housley E, Cawood EH, Macintyre CC, Ruckley CV, Prescott RJ . Edinburgh Artery Study: prevalence of asymptomatic and symptomatic peripheral arterial disease in the general population. Int J Epidemiol 1991; 20: 384–392.

    Article  CAS  PubMed  Google Scholar 

  167. Bhuripanyo P, Suwanwatana C, Kiatsayompoo S, Graisopa S, Prasertkaew S, Bhuripanyo K et al. Vascular Complications in Noninsulin Dependent Diabetes Mellitus (NIDDM) in Srinagarind Hospital, Khon Kaen. J Med Assoc Thailand 1992; 75(10): 570–577.

    CAS  Google Scholar 

  168. Bowlin SJ, Medalie JH, Flocke SA, Zyzanski SJ, Goldbourt U . Epidemiology of intermittent claudication in middle-aged men. Am J Epidemiol 1994; 140(5): 418–430.

    Article  CAS  PubMed  Google Scholar 

  169. Selvin E, Erlinger TP . Prevalence of and risk factors for peripheral arterial disease in the United States: results from the National Health and Nutrition Examination Survey, 1999–2000. Circulation 2004; 110(6): 738–743.

    Article  PubMed  Google Scholar 

  170. Gordon WC, Freeman JM, Roberts MH . A new look at peripheral vascular disease in blacks: A two-year update. J Natl Med Assoc 1980; 72(12): 1177–1183.

    PubMed  PubMed Central  Google Scholar 

  171. Robbs JV . Atherosclerotic peripheral arterial disease in blacks – an established problem. SA Med J 1985; 67: 797–801.

    CAS  Google Scholar 

  172. Sidaway AN, Schweitzer EJ, Neville RF, Alexander EP, Temeck BK, Curry KM . Race as a risk factor in the severity of infragenicular occlusive disease: study of an urban hospital population. J Vasc Surg 1990; 11(4): 536–543.

    Article  Google Scholar 

  173. Kinare SG, Kher YR, Rao G, Sen PK . Pattern of occlusive peripheral vascular disease in India. Angiology 1976; 27(3): 165–180.

    Article  CAS  PubMed  Google Scholar 

  174. Shead GV, Oomen RM, Savarirayan SS . The pattern of non-diabetic peripheral vascular disease in South India. Br J Surg 1978; 65: 49–53.

    Article  CAS  PubMed  Google Scholar 

  175. Freedman DS, Newman WP, Tracy RE, Voors AE, Srinivasan SR, Webber LS et al. Blach-white differences in aortic fatty streaks in adolescence and early adulthood: the Bogalusa Heart Study. Circulation 1988; 4: 856–864.

    Article  Google Scholar 

  176. LaMorte WW, Scott TE, Menzoian JO . Racial differences in the incidence of femoral bypass and abdominal aortic aneurysmectomy in Massachusetts: relationship to cardiovascular risk factors. J Vasc Surg 1995; 21: 422–431.

    Article  CAS  PubMed  Google Scholar 

  177. Huber TS, Wang JG, Wheeler KG, Cuddeback JK, Dame DA, Ozaki CK et al. Impact of race on the treatment for peripheral arterial occlusive disease. J Vasc Surg 1999; 30(3): 417–425.

    Article  CAS  PubMed  Google Scholar 

  178. Tunis SR, Bass EB, Klag MJ, Steinburg EP . Variation in utilization of procedures for treatment of peripheral arterial disease. Arch Intern Med 1993; 153: 991–998.

    Article  CAS  PubMed  Google Scholar 

  179. Guadagnoli E, Ayanian JZ, Gibbons G, McNeil BJ, LoGerfo FW . The influence of race on the use of surgical procedures for treatment of peripheral vascular disease of the lower extremities. Arch Surg 1995; 130: 381–386.

    Article  CAS  PubMed  Google Scholar 

  180. Lavery LA, Ashry HR, van Houtum W, Pugh JA, Harkless LB, Basu S . Variation in the incidence and proportion of diabetes-related amputations in minorities. Diabetes Care 1996; 19: 87–91.

    Google Scholar 

  181. Resnick HE, Valsania P, Phillips CL . Diabetes mellitus and nontraumatic lower extremity amputation in black and white Americans. Arch Intern Med 1999; 159: 2470–2475.

    Article  CAS  PubMed  Google Scholar 

  182. Brothers TE, Robison JG, Elliot BM . Diabetes mellitus is the major risk factor for African Americans who undergo peripheral bypass graft operations. J Vasc Surg 1999; 29(2): 352–359.

    Article  CAS  PubMed  Google Scholar 

  183. Collins TC, Johnson M, Henderson W, Khuri SF, Daley J . Lower extremity nontraumatic amputation among veterans with peripheral arterial disease: is race an independent factor? Med Care 2002; 40(1 Suppl): I106–I116.

    PubMed  Google Scholar 

  184. Rucker-Whitaker C, Greenland P, Liu K, Chan C, Guralnik JM, Criqui MH et al. Peripheral arterial disease in African Americans: clinical characteristics, leg symptoms, and lower extremity functioning. J Am Geriatr Soc 2004; 52(6): 922–930.

    Article  PubMed  Google Scholar 

  185. Rucker-Whitaker C, Feinglass J, Pearce WH . Explaining racial variation in lower extremity amputation: a 5-year retrospective claims data and medical record review at an urban teaching hospital. Arch Surg 2003; 138(12): 1347–1351.

    Article  PubMed  Google Scholar 

  186. Feinglass J, Rucker-Whitaker C, Lindquist L, McCarthy WJ, Pearce WH . Racial differences in primary and repeat lower extremity amputation: results from a multihospital study. J Vasc Surg 2005; 41(5): 823–829.

    Article  PubMed  Google Scholar 

  187. Collins TC, Petersen NJ, Suarez-Almazor M, Ashton CM . Ethnicity and peripheral arterial disease. Mayo Clin Proc 2005; 80(1): 48–54.

    Article  PubMed  Google Scholar 

  188. Madiba TE, Mars M, Robbs JV . Aorto-Iliac occlusive disease in the different population groups – clinical pattern, risk profile and results of reconstruction. SA Med J 1999; 89(12): 1288–1292.

    CAS  Google Scholar 

  189. Toursarkissian B, Shireman PK, Harrison A, D’Ayala M, Schoolfield J, Sykes MT . Major lower-extremity amputation: contemporary experience in a single Veterans Affairs institution. Am Surg 1002; 68(7): 606–610.

    Google Scholar 

  190. Leggetter S, Chaturvedi N, Fuller JH, Edmonds ME . Ethnicity and risk of diabetes-related lower extremity amputation: a population-based, case-control study of African Caribbeans and Europeans in the United kingdom. Arch Intern Med 2002; 162(1): 73–78.

    Article  PubMed  Google Scholar 

  191. Wilmink TB, Quick CR, Day NE . The association between cigarette smoking and abdominal aortic aneurysms. J Vasc Surg 1999; 30(6): 1099–1105.

    Article  CAS  PubMed  Google Scholar 

  192. Adachi K, Iwasawa T, Ono T . Screening for abdominal aortic aneurysms during a basic medical checkup in residents of a Japanese rural community. Surg Today 2000; 30: 594–599.

    Article  CAS  PubMed  Google Scholar 

  193. Costa M, Robbs JV . Abominal aortic aneurysms in a black population:clinicopathological study. Br J Surg 1985; 73: 554–558.

    Article  Google Scholar 

  194. Spark JI, Baker JL, Vowden P, Wilkinson D . Epidemiology of abdominal aortic aneurysms in the Asian community. Br J Surg 2001; 88(3): 382–384.

    Article  CAS  PubMed  Google Scholar 

  195. Johnson G, Avery A, McDougal G, Burnham SJ, Keagy BA . Aneurysms of the abdominal aorta: Incidence in Blacks and Whites in North Carolina. Arch Surg 1985; 120: 1138–1140.

    Article  PubMed  Google Scholar 

  196. Kitchen ND . Racial distribution of aneurysms in Zimbabwe. J Roy Soc Med 1989; 82: 136–138.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  197. Dardik A, Lin JW, Gordon TA, Williams GM, Perler BA . Results of elective abdominal aortic aneurysm repair in the 1990s: a population-based analysis of 2335 cases. J Vasc Surg 1999; 30: 985–995.

    Article  CAS  PubMed  Google Scholar 

  198. Fratiglioni L, Arfaioli C, Nencini P, Ginanneschi A, Iaquinta L, Marchi M et al. Transient ischaemic attacks in the community: occurrence and clinical characteristics: a population survey in the area of Florence, Italy. Neuroepidemiology 1989; 8: 87–96.

    Article  CAS  PubMed  Google Scholar 

  199. Lemesle M, Milan C, Faivre J, Moreau T, Giroud M, Dumas R . Incidence trends of ischemic stroke and transient ischemic attacks in a well-defined French population from 1985 through 1994. Stroke 1999; 30(2): 371–377.

    Article  CAS  PubMed  Google Scholar 

  200. Wolfe CDA, Giroud M, Kolominsky-Rabas P, Dundas R, Lemesle M, Heuschmann P et al. Variations in stroke incidence and survival in 3 areas of Europe. Stroke 2000; 31: 2074–2079.

    Article  CAS  PubMed  Google Scholar 

  201. Gibbs RGJ, Newson R, Lawrenson R, Greenhalgh RM, Davies AH . Diagnosis and initial management of stroke and transient ischaemic attack across UK health regions from 1992 to 1996: Experience of a national primary care database. Stroke 2001; 32: 1085–1090.

    Article  CAS  PubMed  Google Scholar 

  202. Oddone EZ, Horner RD, Sloane R, McIntyre L, Ward A, Whittle J et al. Race, presenting signs and symptoms, use of carotid artery imaging, and appropriateness of carotid endarterectomy. Stroke 1999; 30(7): 1350–1356.

    Article  CAS  PubMed  Google Scholar 

  203. Horner RD, Oddone EZ, Stechuchak KM, Grambow SC, Gray J, Khuri SF et al. Racial variation in postoperative outcomes of carotid endarterectomy. Med Care 2002; 40(1, Supplement): I-35-I-43.

  204. Aronow WS . Prevalence of atherothrombotic brain infarction, coronary artery disease and peripheral arterial disease in elderly black patients, Hispanic patients and white patients. Am J Cardiol 1992; 70: 1212–1213.

    Article  CAS  PubMed  Google Scholar 

  205. Qureshi AI, Suri MA, Safdar K, Ottenlips JR, Janssen RS, Frankel MR . Intracerebral hemorrhage in blacks. Risk factors, subtypes, and outcome. Stroke 1997; 28(5): 961–964.

    Article  CAS  PubMed  Google Scholar 

  206. Woo D, Gebel J, Miller R, Kothari R, Brott T, Khoury J et al. Incidence rates of first-ever ischemic stroke subtypes among blacks: a population-based study. Stroke 1999; 30(12): 2517–2522.

    Article  CAS  PubMed  Google Scholar 

  207. Ness J, Aronow WS . Prevalence of coronary artery disease, ischaemic stroke, peripheral arterial disease, and coronary revascularization in older African-Americans, Asians, Hispanics, Whites, men and women. Am J Cardiol 1999; 84: 932–933.

    Article  CAS  PubMed  Google Scholar 

  208. Ayala C, Greenlund KJ, Croft JB, Keenan NL, Donehoo RS, Giles WH et al. Racial/ethnic disparities in mortality by stroke subtype in the United States, 1995–1998. Am J Epidemiol 2001; 154(11): 1057–1063.

    Article  CAS  PubMed  Google Scholar 

  209. Lemic-Stojcevic N, Dundas R, Jenkins S, Rudd A, Wolfe C . Preventable risk factors for coronary heart disease and stroke amongst ethnic groups in London. Ethn Health 2001; 6(2): 87–94.

    Article  CAS  PubMed  Google Scholar 

  210. Sacco RL, Roberts JK, Boden-Albala B, Gu Q, Lin IF, Kargman DE et al. Race-ethnicity and determinants of carotid atherosclerosis in a multiethnic population. The Northern Manhattan Stroke Study. Stroke 1997; 28(5): 929–935.

    Article  CAS  PubMed  Google Scholar 

  211. Padma MV, Gaikwad S, Jain S, Maheshwari MC, Misra NK . Distribution of vascular lesions in ischaemic stroke: a magnetic resonance angiographic study. Natl Med J India 1997; 10(5): 217–220.

    CAS  PubMed  Google Scholar 

  212. Criqui HM, Vargas V, Denenberg JO, Ho E, Allison M, Langer RD et al. Ethnicity and peripheral arterial disease. Circulation 2005; 112: 2703–2707.

    Article  PubMed  Google Scholar 

  213. Jolliffe J, Rees K, Taylor R, Thompson D, Oldridge N, Ebrahim S . Exercise-Based Rehabilitation for CHD (Cochrane Review). The Cochrane Library. Update software: Oxford, 2003.

    Google Scholar 

  214. Taylor RS, Brown A, Ebrahim S, Jolliffe J, Noorani H, Rees K et al. Exercise-based rehabilitation for patients with CHD: systematic review and meta-analysis of randomized controlled trials. Am J Med 2005; 116(10): 682–692.

    Article  Google Scholar 

  215. Bethell H, Turner S, Evans J, Rose L . Cardiac rehabilitation in the United Kingdom: how complete is the provision? J Cardiopulm Rehab 2001; 21: 111–115.

    Article  CAS  Google Scholar 

  216. Campbell N, Grimshaw J, Rawles J, Ritchie L . Cardiac rehabilitation in Scotland: is current provision satisfactory? J Public Health Med 1996; 18(4): 478–480.

    Article  CAS  PubMed  Google Scholar 

  217. Evans J, Turner S, Bethell H . Cardiac rehabilitation: are the NSF milestones achevable? Heart 2002; 87(Suppl(ii)): 411.

    Google Scholar 

  218. Melville M, Packham C, Brown N, Weston C, Gray D . Cardiac rehabilitation: socially deprived patients are less likely to attend but patients ineligible for thrombolysis are less likely to be invited. Heart 1999; 82: 373–377.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  219. Pell J, Pell A, Morrison C, Blatchford O, Dargie H . Retrospective study of influence of deprivation on uptake of cardiac rehabilitation. BMJ 1996; 313: 267–268.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  220. Cannistra L, O’Malley C, Balady G . Comparison of outcome of cardiac rehabilitation in black women and white European women. Am J Cardiol 1995; 75: 890–893.

    Article  CAS  PubMed  Google Scholar 

  221. King K, Humen D, Teo K . Cardiac rehabilitation: the forgotten intervention. Can J Cardiol 1999; 15: 979–985.

    CAS  PubMed  Google Scholar 

  222. Todd A, Wadsworth E, Asif S, Gerrish K . Cardiac rehabilitation: the needs of South Asian cardiac patients. Br J Nurs 2001; 10(16): 1028–1033.

    Article  Google Scholar 

  223. Cortes O, Arthur H . Determinants of referral to cardiac rehabilitation programs in patients with CHD: a systematic review. Am Heart J 2006; 151: 249–256.

    Article  PubMed  Google Scholar 

  224. Farooqi A, Bhavsar M . Project Dil: a co-ordinated primary care and community health promotion programme for reducing risk factors of CHD amongst the South Asian community of Leicester – experiences and evaluation of the project. Ethn Health 2001; 6: 265–270.

    Article  CAS  PubMed  Google Scholar 

  225. Brunner EJ, Thorogood M, Rees K, Hewitt G . Dietary advice for reducing cardiovascular risk. Cochrane Database Syst Rev 2005; 19(4): CD002128.

    Google Scholar 

  226. Hooper L, Bartlett C, Davey smith G, Ebrahim S . Advice to reduce dietary salt for prevention of cardiovascular disease. The Cochrane Database Syst Rev 2004; (1): CD003656.

  227. Hooper L, Summerbell C, Higgins JPT, Thompson RL, Clements G, Capps N et al. Reduced or modified dietary fat for preventing cardiovascular disease. The Cochrane Database Syst Rev 2001; (3): CD002137.

  228. Kelly S, Frost S, Whittaker V, Summerbell C . Low glycaemic index diets for coronary heart disease. Cochrane Database Syst Rev 2004; 18(4): CD004467.

    Google Scholar 

  229. Heart Disease in South Asians. Department of Health 2004. http://www.gov.uk/heart/heartfailure/developingservices.

  230. Sproston K, Primatesta P (eds). Health Survey for England Volume 2: Risk Factors for Cardiovascular Disease. TSO: London, 2004.

    Google Scholar 

  231. Johnson MR, Owen D, Blackburn C . Black and Ethnic Minority Groups in England: The Second Health & Lifestyles Survey. Health Education Authority: London, 2000.

    Google Scholar 

  232. Hillsdon M, Foster C, Thorogood M . Interventions for promoting physical activity. Cochrane Database Syst Rev 2005; 25(1): CD003780.

    Google Scholar 

  233. National Institute for Health & Clinical Excellence. Four commonly used methods to increase physical activity: brief interventions in primary care, exercise referral schemes, pedometers and community-based exercise programmes for walking and cycling. Public Health Intervention Guidance no.2. March 2006.

  234. Kuppuswamy V, Jhuree V, Gupta S . CHD in South Asian prevention (CADISAP) study: a culturally sensitive cardiac rehabilitation (CR): can it improve uptake and adherence of CR among South Asians? Heart 2004; 90(Suppl II): abstract 177, A51.

  235. Eftekhari H, Marson P, Mattu R, Trevelyan J, Needham T . Improving a cardiac rehabilitation programme for Asian patients in Coventry. Coronary Health Care 2000; 4: 210–222.

    Article  Google Scholar 

  236. Radford J, Twells C, Brown K . Nottingham community cardiac rehabilitation & support service: aiming to deliver in a deprived inner-city area. British Association of Cardiac Rehabilitation Annual Conference 2005.

Download references

Acknowledgements

The Introduction section uses some material from PS Gill, J Kai, RS Bhopal, S Wild Health Care Needs Assessment: Black and Minority Ethnic Groups. In: A Stevens, J Raftery & JM Mant (eds). Health Care Needs Assessment. The epidemiologically based needs assessment reviews. Third Series. Radcliffe Medical Press, Oxford. (http://hcna.radcliffe-oxford.com/bemgframe.htm). This document has been peer-reviewed by the following, whose suggestions are gratefully acknowledged: Rubin Minhas, Gene Feder, Sandy Gupta and Raj Bophal. GYHL chaired the group and the document was co-edited by GYHL and KP.

Author information

Authors and Affiliations

  1. University Department of Medicine, City Hospital, Birmingham, UK

    G Y H Lip

  2. University Department of Diabetes and Endocrinology, Heart of England NHS Foundation Trust, Birmingham, UK

    A H Barnett

  3. University Department of Vascular Surgery, Heart of England NHS Foundation Trust, Birmingham, UK

    A Bradbury

  4. Clinical Sciences Research Institute, Warwick Medical School, Coventry, UK

    F P Cappuccio

  5. Department of Primary Care and General Practice, University of Birmingham, Birmingham, UK

    P S Gill

  6. Department of Clinical Chemistry, Sandwell and West Birmingham NHS Trust, West Bromwich, UK

    E Hughes

  7. Department of Vascular Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK

    C Imray

  8. Department of Public Health and Epidemiology, University of Birmingham, Birmingham, UK

    K Jolly

  9. Department of Cardiology, Sandwell and West Birmingham NHS Trust, West Bromwich, UK

    K Patel

Authors
  1. G Y H Lip
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A H Barnett
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A Bradbury
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. F P Cappuccio
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P S Gill
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. E Hughes
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. C Imray
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. K Jolly
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. K Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G Y H Lip.

Additional information

Supplementary Information accompanies the paper on the Journal of Human Hypertension website (http://www.nature.com/jhh)

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lip, G., Barnett, A., Bradbury, A. et al. Ethnicity and cardiovascular disease prevention in the United Kingdom: a practical approach to management. J Hum Hypertens 21, 183–211 (2007). https://doi.org/10.1038/sj.jhh.1002126

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jhh.1002126

Keywords

This article is cited by

Search

Advanced search

Quick links