Clinical research - health care outcomeOutcomes in Young South Asian Canadians After Acute Myocardial Infarction
Section snippets
Study population
This retrospective cohort study included patients with AMI, 20-55 years of age residing in British Columbia and the Calgary Health Region, Canada. Data were obtained from routinely collected hospital administrative discharge records from April 1, 1995 to March 31, 2002. The hospital discharge abstract database (DAD) contains demographic and clinical data with up to 25 diagnoses for each hospital discharge. Patients were identified as having an AMI based on validated International Classification
Results
Of the 40,669 patients identified with AMI, there were 7135 patients younger than the age of 55. Of these, 487 patients (6.8%) were categorized as South Asian. Patients were followed for up to 8 years (mean 4.2 years). The young cohort had a significantly lower percentage of women and overall lower prevalence of comorbidities compared with the cohort older than the age of 55.
Baseline characteristics are presented in Table 1. Both ethnic groups were similar in most aspects. However, South Asian
Discussion
In our study, we found no significant differences in fatal and nonfatal events after AMI. While there is recognition of the increased cardiovascular mortality among young South Asian patients, there has been minimal work done in examining outcomes of young survivors of AMI. Our work provides a closer examination of this young population at high risk for future cardiovascular complications. With a large population-based study and several years of follow-up, we were able to follow young South
Conclusions
Premature atherosclerosis remains a major health concern among young South Asians. When adjusting for sociodemographic factors and comorbidities, we found no difference in fatal and nonfatal outcomes after AMI among South Asian and white patients younger than the age of 55.
Although it is recognized that young South Asian patients have a high prevalence of AMI, they are not experiencing worse outcomes relative to young white patients, according to results in our study. The complex factors and
Funding Sources
This study was funded by the Canadian Institutes of Health Research (CIHR). CIHR had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.
Disclosures
The authors have no conflicts of interest to disclose.
Acknowledgements
We thank the British Columbia Cardiac Registry, the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH), and the British Columbia and Alberta Ministries of Health for providing access to data.
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The Morphology of Coronary Artery Disease in South Asians vs White Caucasians and Its Implications
2022, Canadian Journal of CardiologyCitation Excerpt :While some studies suggest, counterintuitively, that there may be improved survival in SAs,25 this has not been supported by other studies.15,16 Overall, analysis of CAD prevalence and outcomes in SAs compared with WCs reveals that SAs tend to experience a higher prevalence and earlier onset of CAD with similar short-term mortality rates25-27 and similar or lower long-term mortality rates.25,27-30 The impact of traditional cardiac risk factors on the development of CAD in SAs has been previously well represented,10,31,32 as summarised in Table 2.
Ethnic differences in acute heart failure outcomes in Ontario
2019, International Journal of CardiologyCitation Excerpt :There appears to be an association between ethnicity and health that goes beyond medical care, culture and country of residence. For instance, while native South Asians have a higher burden of cardiovascular risk factors that predispose them to myocardial infarction (MI) earlier in life, the same burden of cardiovascular risk factors have been observed in South Asian emigrants presenting with acute MI, who have been long-term residents of Canada [10]. In addition to differences in baseline health status, the implementation of AHF management guidelines may also differ across ethnic groups.
Short and long-term prognosis following acute myocardial infarction according to the country of origin. Soroka acute myocardial infarction II (SAMI II) project
2018, International Journal of CardiologyCitation Excerpt :Furthermore, a previous study from the Netherlands that evaluated patients with first AMI hospitalization found that mortality and AMI or congestive heart failure readmissions were higher in the majority of migrant groups compared with Dutch patients [11]. However, Canadian studies reported that Southern Asians had lower long-term mortality compared with the majority population [24,25]. Although this was not the main objective of the current study, several potential explanations for the observed differences in post AMI outcomes according to the country of origin could be suggested.
Cardiometabolic disease in South Asians: A global health concern in an expanding population
2017, Nutrition, Metabolism and Cardiovascular DiseasesCitation Excerpt :Evidence also points to increased cardiovascular risk in second generation SA immigrants, which starts developing at a relatively early age [53–57]. Prognosis after CAD has been addressed by few studies with no difference in-hospital mortality in SAs (relative to Europeans) [17,58–62]. While the prevalence of acute HF in SAs relative to other ethnicities is largely unexplored, SAs may have improved prognosis after HF diagnosis, owing to greater prevalence of preserved left ventricular function, lower rates of atrial fibrillation, and potentially a younger age at presentation [28,63,64].
Cardiovascular Disease in South Asian Migrants
2015, Canadian Journal of CardiologyCitation Excerpt :In a study of acute MI in Ontario, Canada, SAs and Europids had equivalent in-hospital mortality (9.6% and 7.8% respectively; P = 0.27).31 Similarly, in a study of patients aged 20-55 years in British Columbia, Canada, SAs had similar 30-day and long-term mortality compared with Europids.32 In a United Kingdom–based study, SAs tended to present more acutely when requiring percutaneous coronary intervention (PCI) but had long-term mortality rates similar to those of Europids.33
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