Zaman, M.J.S.; (2009) Prognosis of angina and myocardial infarction in South Asian and white populations in the United Kingdom. Doctoral thesis , UCL (University College London).

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Abstract

Background: Coronary mortality rates amongst South Asian populations are higher than in White populations in the UK. The contribution of incidence and prognosis of coronary disease to the higher coronary mortality rates amongst South Asian populations is unknown. Incident coronary disease commonly presents as angina and non-fatal myocardial infarction rather than as fatal events. Aim: This thesis sought to investigate the incidence and prognosis of differing clinical presentations of coronary disease such as angina and myocardial infarction in South Asian compared to White populations in the UK. Methods: Four new prospective studies, one aetiologic (South Asian N=580 initially healthy) and three prognostic (N=2189 with suspected new-onset stable angina, N=502 undergoing coronary angiography and N=3037 with acute coronary syndromes) were examined, using multi-variate regression analyses. A systematic review and meta-analysis of these and previously published studies was performed. Results: • Incidence of angina was higher in South Asian than in White people in a healthy population, and angina was similarly valid in predicting a poor prognosis in both ethnic groups compared to those with no chest pain. • In those with chronic angina, South Asian patients did not have a higher future risk of myocardial infarction and death than White patients, but had a worse symptomatic prognosis following coronary revascularisation when compared to White patients. • South Asian patients had no worse a prognosis for mortality than White patients after myocardial infarction • On meta-analysis, incidence of fatal and non-fatal coronary disease was higher in South Asian populations compared to White populations whilst prognosis of coronary disease in South Asian populations was not worse than in White populations. Conclusions: Increased coronary mortality rates in South Asian populations compared to the White populations are due to the higher incidence of fatal and non-fatal coronary disease in South Asian people, as the prognosis of manifest coronary disease in South Asian people is not worse than in White people.

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