Hughes L O, Raval U, Raftery E B
Department of Cardiology, Northwick Park Hospital and Clinical Research Centre, Harrow, Middlesex.
BMJ. 1989 May 20;298(6684):1345-50. doi: 10.1136/bmj.298.6684.1345.
To compare the presentation and natural course of first myocardial infarctions in immigrant Asians and the indigenous white population in Britain and the subsequent risk states of the two groups.
Prospective ethnic comparison of consecutive patients with first myocardial infarctions.
Secondary referrals to a coronary care unit of a district general hospital.
128 Men (77 white, 54 Asian) presenting consecutively with a first myocardial infarction diagnosed on the basis of clinical, biochemical, and electrocardiographic findings.
Identification of mechanisms accounting for the increased rate of ischaemic heart disease in Asians.
Infarct size was assessed by measuring the release of creatine phosphokinase (all patients), radionuclide ventriculography (50), and contrast ventriculography (103). Risk states after infarction were assessed from the degree of ventricular dysfunction as determined by exercise electrocardiography (82 patients) and from the extent of coronary atheroma as determined by coronary arteriography (103). Glucose state was measured in fasting venous blood samples. Overall the relative rate of infarction was 4.9 times higher in Asians (95% confidence interval 3.4 to 6.9) than in the white population. Moreover, the relative rate of infarction was higher in Asians in all 10 year age groups, the greatest difference being in 30-39 year olds. The mean age of the Asian denominator population was 47.1 years compared with 49.5 years in the white population. Age at infarction was less in Asians (50.2 years) than in white patients (55.5 years; mean difference 5.5 years (95% confidence interval 2.5 to 7.1]. In Asians the mean creatine phosphokinase activity was 777 (95% confidence interval 155 to 1399) U/1 higher, radionuclide ejection fraction 8.9% (1.0% to 16.9%) lower, and left ventricular fractional shortening 4.8% (1.4% to 8.2%) lower than in white patients. The extent of coronary atheroma was significantly greater in Asians. The mean numbers of plaques in vessels not associated with infarction were 3.66 (median 3.0, range 0-10) in Asians compared with 1.97 (median 2.0, range 0-6) in white patients (p less than 0.001), and a higher proportion of Asians had three vessel coronary artery disease (p less than 0.001). Asians with diabetes or impaired glucose tolerance did not differ from those with normal blood glucose values.
Atherogenesis arises earlier in Asians, contributing to premature first myocardial infarctions. The increased incidence of diabetes in Asians may not in itself be relevant in the greater propensity to coronary atheroma in Asians.
比较英国亚裔移民和本土白人首次心肌梗死的临床表现、自然病程以及两组随后的风险状态。
对首次发生心肌梗死的连续患者进行前瞻性种族比较。
一家地区综合医院冠心病监护病房的二次转诊患者。
128名男性（77名白人，54名亚裔），根据临床、生化和心电图检查结果连续诊断为首次心肌梗死。
确定导致亚裔缺血性心脏病发病率增加的机制。
通过测量肌酸磷酸激酶释放量（所有患者）、放射性核素心室造影（50例）和造影剂心室造影（103例）评估梗死面积。根据运动心电图确定的心室功能障碍程度（82例患者）和冠状动脉造影确定的冠状动脉粥样硬化程度（103例）评估梗死后的风险状态。在空腹静脉血样本中测量血糖状态。总体而言，亚裔梗死的相对发生率比白人高4.9倍（95%置信区间3.4至6.9）。此外，在所有10岁年龄组中亚裔梗死的相对发生率都更高，最大差异在30 - 39岁年龄组。亚裔分母人群的平均年龄为47.1岁，而白人为49.5岁。亚裔发生梗死时的年龄（50.2岁）低于白人患者（55.5岁；平均差异5.5岁（95%置信区间2.5至7.1）。亚裔患者的平均肌酸磷酸激酶活性比白人高777（95%置信区间155至1399）U/1，放射性核素射血分数低8.9%（1.0%至16.9%），左心室缩短分数低4.8%（1.4%至8.2%）。亚裔的冠状动脉粥样硬化程度明显更严重。亚裔中与梗死无关血管的平均斑块数为3.66（中位数3.0，范围0 - 10），而白人患者为1.97（中位数2.0，范围0 - 6）（p<0.001），且患三支血管冠状动脉疾病的亚裔比例更高（p<0.001）。患有糖尿病或糖耐量受损的亚裔与血糖值正常的亚裔没有差异。
亚裔动脉粥样硬化发生得更早，导致过早发生首次心肌梗死。亚裔糖尿病发病率的增加本身可能与亚裔更易患冠状动脉粥样硬化无关。
