Diabetes and CVD in South Asians: A review

Journal of Diabetes Nursing Vol 12 No 6 2008 The prevalence of diabetes and cardiovascular disease in this population is disproportionately high: diabetes is almost six times greater (Mather and Keen, 1985) and mortality from CVD nearly twice as common compared with the local Caucasian population (Chaturvedi and Fuller, 1996). Epidemiological studies have shown that this excess risk is due to a higher prevalence of insulin resistance and an unfavourable CV risk profile more commonly seen in South Asians (McKeigue et al, 1991). This is further compounded by economic deprivation, poor access to healthcare, and cultural practices that make it difficult to deliver optimal care. This is thought to be due to a combination of genetic and environmental factors (Reddy and Yusuf, 1998). The genetics of type 2 diabetes is complex and involves interaction of several genes with the environment (Barroso, 2005; Ramachandran et al, 1992). Although no single gene has been implicated in the causation of type 2 diabetes, better understanding of the pathogenesis and improved techniques of genetic testing have allowed identification of several susceptibility genes associated with the condition (Grant et al, 2006; Ramachandran et al, 2006). Most of these studies have been in Caucasians and until recently there have been very few genetic studies in South Asians. Despite the widely-held belief that South Asians may be genetically different to other ethnic populations, studies involving South Asians have so far not demonstrated any significant differences between the ethnic groups. On the other hand, features of insulin resistance have been identified in early childhood in South Asians suggesting a possible genetic predisposition (Krishnaveni et al, 2005). In contrast, evidence for environmental Diabetes and CVD in South Asians: A review