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Risk of cardiovascular disease high among second-generation Indians in Singapore

Tristan Manalac
5 days ago

There is a significant generational difference in the incidence of cardiovascular diseases (CVD) and its associated risk factors among individuals of Indian ethnicity in Singapore, a recent study has shown.

“We demonstrated that second-generation Indian individuals had increased risk of incident CVD, hyperlipidaemia and chronic kidney disease (CKD) compared to first-generation immigrants, independent of conventional cardiovascular risk factors,” said researchers.

The study included 1,749 first-generation (n=406; mean age 58.1±10.2 years; 52.2 percent male) and second-generation (n=1,343; mean age 54.8±8.2 years; 46.2 percent male) Indians, of whom 4.1 percent (n=73) developed CVD over a 6-year follow-up period. Relative to first-generation immigrants, second-generation Indians had significantly higher cumulative incidence rates of CVD, myocardial infarction, CKD and hyperlipidaemia (p<0.05 for all). [Sci Rep 2018;8:14805]

Multivariable analyses confirmed these findings. After complete adjustments for demographic variables, smoking and alcohol habits, comorbidities, and the use of medications, researchers showed that second-generation Indians were more than twice as likely than their first-generation counterparts to develop CVD (relative risk [RR], 2.04; 95 percent CI, 1.04–3.99; pp=0.038).

However, when analysis was stratified according to CVD subtypes, the significance of generation was attenuated (myocardial infarction: RR, 2.26; 0.87–5.89; p=0.095; stroke: RR, 2.01; 0.76–5.36; p=0.161; angina: RR, 1.73; 0.56–5.38; p=0.345).

In terms of risk factors, the risk of developing hyperlipidaemia (RR, 1.27; 1.06–1.53; p=0.011) or CKD (RR, 1.92; 1.22–3.04; p=0.005) was significantly elevated in the second- vs first-generation Indians. No such effect was observed for other risk factors such as diabetes (RR, 1.16; 0.81–1.66; p=0.407), hypertension (RR, 1.07; 0.85–1.34; p=0.573) and obesity (RR, 1.26; 0.76–2.11; p=0.374).

Notably, a longer length of stay in Singapore was significantly and independently associated with higher risks of hyperlipidaemia (RR, 1.12; 1.05–1.20; p=0.001) and CKD (RR, 1.26; 1.07–1.48; p=0.005) among Indian immigrants.

“To the best of our knowledge, this is the first longitudinal study to examine the impact of generation on incidence of CVD and its major risk factors in Asians, making it challenging to compare our findings,” according to researchers, adding that the presently obtained trends reflect those observed in Western populations. [Ann Epidemiol 2016;26:429-435.e1]

“Our findings confirm the growing body of evidence from previous cross-sectional studies that demonstrated higher prevalence of CVD, its conventional risk factors, and potentially modifiable CVD risk factors such as diet, physical inactivity and psychological stress in more acculturated second-generation individuals than less acculturated first-generation immigrants,” they added. [Am J Epidemiol 2000;152:548-557]

The economic prosperity of the country of birth may also partially account for the observed associations, researchers explained. That is, “being born in a developed country like Singapore with a ‘high-risk’ lifestyle such as sedentary employment, consumption of more energy-dense processed foods, lack of physical activity and psychological stress, may be the contributing factors.”

Nevertheless, the present study has identified a pressing issue in a key population and may help facilitate decisions and policies directed to solving such problems.

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