Cardiovascular risk among South Asians living in Canada: a systematic review and meta-analysis

Abstract

Background: South Asians represent about 3% of the Canadian population and have a higher burden of certain cardiovascular risk factors and cardiovascular disease (CVD) compared with white people. The objective of this study was to review the literature to compare cardiovascular risk factors and disease management practices among adult South Asian and white Canadians.

Methods: We searched MEDLINE, Embase, Cochrane and Cumulative Index to Nursing and Allied Health Literature databases from their inception through Feb. 17, 2014 and the reference lists of the selected articles. English-language studies of interventions and observational studies of biological mechanisms underlying CVD risk in South Asians conducted in Canada were eligible for inclusion. Where appropriate, we used random-effects meta-analyses to integrate results comparing the CVD risk profiles of South Asian and white Canadians.

Results: We included 50 articles (n = 5 805 313 individuals) in this review. Compared with white Canadians, South Asian Canadians had a higher prevalence and incidence of CVD, an increased prevalence of diabetes (odds ratio [OR] 2.25, 95% confidence interval [CI] 1.81 to 2.80, p < 0.001) and hypertension (OR 1.11, 95% CI 1.02 to 1.22, p = 0.02), lower high-density lipoprotein cholesterol levels (mean difference -0.19 mmol/L, 95% CI -0.25 to -0.13 mmol/L, p < 0.001) and a higher percentage of body fat (men: absolute mean difference 3.23%, 95% CI 0.83% to 5.62%, p = 0.008; women: absolute mean difference 4.09%, 95% CI 3.46% to 4.72%, p < 0.001). South Asian people are also more sedentary, consume higher levels of carbohydrates and are less likely to smoke tobacco (OR 0.38, 95% CI 0.24 to 0.60, p < 0.001]) than white Canadians. No differences in access to diagnostic tests, outcomes following cardiovascular surgery or use of cardiac rehabilitation programs were apparent.

Interpretation: Compared with white people, South Asian people living in Canada have a higher prevalence and incidence of CVD and possess a unique cardiovascular risk profile.

Figure 1:

Selection of studies comparing cardiovascular risk factor and disease management practices among adult South Asian and white Canadians. CVD = cardiovascular disease.

Figure 2:

Meta-analysis of studies evaluating differences in body mass index between South Asian and white Canadian men (A) and women (B). A mean difference greater than zero indicates higher BMI among South Asian people. BMI = body mass index, CI = confidence interval, SD = standard deviation.

Figure 3:

Meta-analysis of studies evaluating differences in percentage body fat between South Asian and white Canadian men (A) and women (B). A mean difference greater than zero indicates higher percentage body fat among South Asian people. CI = confidence interval, SD = standard deviation.

Figure 4:

Meta-analysis of studies evaluating the prevalence of diabetes among South Asian versus white Canadian men (A) and women (B). An odds ratio greater than 1.0 indicates an increased risk of diabetes among South Asian people. CI = confidence interval.