Patel D J, Winterbotham M, Sutherland S E, Britt R G, Keil J E, Sutton G C
Department of Cardiology, Hillingdon Hospital, Uxbridge, Middlesex, United Kingdom.
Natl Med J India. 1997 Sep-Oct;10(5):210-3.
Migrants from the Indian subcontinent (South Asian migrants) in the United Kingdom have high mortality from coronary heart disease (CHD) in comparison to the indigenous population. Few studies have assessed the prevalence of CHD in South Asians, and the applicability of conventional survey methods in this population is not known. In this pilot random population survey of South Asian men and women living in West London, the prevalence of CHD as judged by the Rose questionnaire, past cardiac history, cardiologist and resting electrocardiogram were compared.
Subjects aged 30-64 years from randomly selected households were invited for a cardiological assessment. A lay person administered the Rose questionnaire and recorded the past cardiac history. A cardiologist also made an independent assessment and a 12-lead electrocardiogram was recorded and analysed according to the Minnesota code.
Three hundred and seventy-six individuals (192 men and 184 women) were assessed. The prevalence of angina in men and women, respectively, was 3.1% and 4.9% by the Rose questionnaire; 2.6% and 2.2% by past cardiac history; and 4.2% and 0.5% according to the cardiologist. The prevalence of myocardial infarction in men and women, respectively, was 5.2% and 2.2% by the Rose questionnaire, 3.6% and zero by past cardiac history and 3.6% and 0.5% by the cardiologist. Q/QS codes were present in 1.6% men and 0.5% women and ischaemic codes in 13% men and 14% women. Ischaemic changes were not associated with any cardiac history in 72% of men and 92% of women. For a diagnosis of CHD in men, there was poor agreement between the Rose questionnaire and either the past cardiac history or the cardiologist's assessment, but moderate agreement between the past cardiac history and the cardiologist. Agreement was poor between all three methods for a positive diagnosis of CHD in women.
Current accepted epidemiological methods for assessing CHD prevalence may be inaccurate in South Asians, especially women. Electrocardiogram abnormalities suggestive of ischaemia are common in South Asians and are usually not associated with evidence of CHD. Thus, their value as indicators of CHD is questionable.
与英国本土居民相比，来自印度次大陆的移民（南亚移民）冠心病（CHD）死亡率较高。很少有研究评估南亚人群中冠心病的患病率，传统调查方法在该人群中的适用性尚不清楚。在这项针对居住在伦敦西部的南亚男性和女性的试点随机人群调查中，比较了通过罗斯问卷、既往心脏病史、心脏病专家诊断和静息心电图判断的冠心病患病率。
邀请从随机抽取的家庭中选取的30 - 64岁受试者进行心脏评估。由一名非专业人员发放罗斯问卷并记录既往心脏病史。一名心脏病专家也进行独立评估，并记录12导联心电图，根据明尼苏达编码进行分析。
共评估了376人（192名男性和184名女性）。根据罗斯问卷，男性和女性心绞痛患病率分别为3.1%和4.9%；根据既往心脏病史分别为2.6%和2.2%；根据心脏病专家诊断分别为4.2%和0.5%。根据罗斯问卷，男性和女性心肌梗死患病率分别为5.2%和2.2%；根据既往心脏病史分别为3.6%和0%；根据心脏病专家诊断分别为3.6%和0.5%。男性中Q/QS编码出现率为1.6%，女性为0.5%；男性缺血性编码出现率为13%，女性为14%。72%的男性和92%的女性中，缺血性改变与任何心脏病史均无关联。对于男性冠心病的诊断，罗斯问卷与既往心脏病史或心脏病专家评估之间一致性较差，但既往心脏病史与心脏病专家评估之间一致性中等。对于女性冠心病的阳性诊断，三种方法之间一致性均较差。
目前公认的评估冠心病患病率的流行病学方法在南亚人群中可能不准确，尤其是在女性中。提示缺血的心电图异常在南亚人群中很常见，且通常与冠心病证据无关。因此，其作为冠心病指标的价值值得怀疑。
