Dhawan J, Bray C L
Department of Cardiology, Wythenshawe Hospital, Southmoor Road, Manchester, UK.
Postgrad Med J. 1994 Sep;70(827):625-30. doi: 10.1136/pgmj.70.827.625.
Asians in the United Kingdom surpass the already high mortality from coronary artery disease seen in Caucasians. In the present study, the angiographic features of consecutive series of 87 Caucasians, 83 British Asian and 30 Asian patients in India with coronary artery disease were assessed. Blood samples at fasting and after ingestion of 75 g of dextrose were taken to assess the extent of diabetes. Fasting blood samples were also taken for measurement of cholesterol, high-density lipoprotein cholesterol and triglyceride. Coronary angiograms were scored by two independent observers who were blinded to the patients' ethnic origin. The Asians were younger than the Caucasians, but did not differ in their body mass index, systolic or diastolic blood pressure or in cigarette consumption. Lipids were similar apart from Indian Asians having lower cholesterol than British Asians, and Caucasians having lower triglyceride than Asians. There were more diabetics in Asians than in Caucasians. Asians in Britain wait longer than Caucasians and Asians in India from onset of angina to undergoing coronary angiography. The presence of triple vessel disease was not significantly different (P = 0.19) in the three groups, that is, 38%, 43% and 27% in Caucasians, British Asians and Indian Asians, respectively. The geometric mean coronary score was 26.3 (C.I. 22.6-30.6), 25.3 (C.I. 21.8-29.4), and 25.2 (C.I. 19.6-32.5) in Caucasians, British Asians and Indian Asians, respectively. This difference was not significant (P = 0.92). Total number of lesions more than three were similar, that is, in 25% Caucasian, 41% British Asian and 40% Indian Asian patients (P < 0.10). British Asians had less proximal disease (P = 0.0002), and Indian Asians less distal disease (P = 0.003) compared to Caucasians. Non-discrete (long) lesions were more prevalent in Asians than Caucasians (P = 0.0005) The total number of lesions more than three in diabetic Asians was significantly more than in the non-diabetic, 71% versus 31% in British Asians (P = 0.002) and 90% versus 15% in Indian Asians (P= 0.0001). The relationship between diabetes and long lesions in both British and Indian Asians was highly significant (P < 0.00001 and P < 0.001, respectively). Thus severity and extent of coronary disease is no different in Asians as compared to Caucasians. Diabetes is perhaps responsible for the more diffuse disease seen in Asians.
在英国，亚洲人的冠状动脉疾病死亡率超过了白种人原本就较高的死亡率。在本研究中，对87名白种人、83名英国亚洲人和30名患有冠状动脉疾病的印度亚洲患者的连续系列血管造影特征进行了评估。采集空腹和摄入75克葡萄糖后的血样以评估糖尿病程度。还采集空腹血样以测量胆固醇、高密度脂蛋白胆固醇和甘油三酯。由两名对患者种族背景不知情的独立观察者对冠状动脉造影进行评分。亚洲人比白种人年轻，但在体重指数、收缩压或舒张压或吸烟量方面没有差异。除印度亚洲人的胆固醇低于英国亚洲人，白种人的甘油三酯低于亚洲人外，血脂情况相似。亚洲人中的糖尿病患者比白种人多。英国的亚洲人从心绞痛发作到接受冠状动脉造影的等待时间比白种人和印度的亚洲人长。三组中三支血管病变的发生率无显著差异（P = 0.19），即白种人、英国亚洲人和印度亚洲人的发生率分别为38%、43%和27%。白种人、英国亚洲人和印度亚洲人的冠状动脉几何平均评分分别为26.3（置信区间22.6 - 30.6）、25.3（置信区间21.8 - 29.4）和25.2（置信区间19.6 - 32.5）。这种差异不显著（P = 0.92）。病变超过三处的总数相似，即白种人中有25%、英国亚洲人中有41%、印度亚洲人中有40%的患者（P < 0.10）。与白种人相比，英国亚洲人的近端病变较少（P = 0.0002），印度亚洲人的远端病变较少（P = 0.003）。与白种人相比，非离散（长）病变在亚洲人中更为普遍（P = 0.0005）。糖尿病亚洲人中病变超过三处的总数显著多于非糖尿病亚洲人，英国亚洲人中分别为71%对31%（P = 0.002），印度亚洲人中为90%对15%（P = 0.0001）。在英国和印度亚洲人中，糖尿病与长病变之间的关系都非常显著（分别为P < 0.00001和P < 0.001）。因此，与白种人相比，亚洲人冠状动脉疾病的严重程度和范围并无不同。糖尿病可能是亚洲人出现更弥漫性疾病的原因。
