ORIGINAL ARTICLE Ethnicity and risk factors for coronary heart disease in diabetes mellitus F. L. Game 1 and A. F. Jones 2 1 Department of Diabetes and Endocrinology, Birmingham Heartlands Hospital, Birmingham, UK 2 Department of Clinical Biochemistry, Birmingham Heartlands Hospital, Birmingham, UK Introduction: TheFraminghamequationcanbeusedtopredicttheriskofcoronaryheartdisease (CHD) and so to target risk factor intervention. Reservations have been applied to its use in south Asian populations since the high CHD mortality in this group may not be accounted for by traditional risk factors. Methods: WeappliedtheFraminghamequationto1826patientswithdiabetesofwhom1215were of white Caucasian and 611 south Asian origin. Having calculated the 10-year CHD risks the contribution of risk factors were compared between ethnic groups. Results: Mean 10-year CHD risk was the same in the two ethnic groups (20.7 vs. 21.5%, white Caucasian vs. south Asian men and 16.5 vs. 15.9%, white Caucasian vs. south Asian women). However,theriskfactorpro®lewasdifferentbetweenthetwogroups.Meantotalcholesterolwas lower in south Asians (5.23 vs. 5.41mmol/l, south Asian vs. white Caucasian men (p=0.01) and 5.38vs.5.68mmol/l,southAsianvs.whiteCaucasianwomen(p<0.001)).HDLcholesterollevels were also lower (median HDL cholesterol 0.94 vs. 1.11mmol/l, south Asian vs. white Caucasian men(p<0.001)and1.07vs.1.3mmol/l,southAsianvs.whiteCaucasianwomen(p<0.0001)) leadingtohighertotal:HDLcholesterolratios(5.48vs.4.78,southAsianvs.whiteCaucasianmen (p=0.032)and4.91vs.4.26,southAsianvs.whiteCaucasianwomen(p<0.001). Conclusion: Calculated 10-year CHD risks are the same in south Asian and white Caucasian diabeticpatientsbutthefactorscontributingtothisriskdiffer.Differentmanagementoftheserisk factors may account for the higher mortality from CHD in those of south Asian origin. Keywords: coronary heart disease risk, diabetes, ethnicity, Framingham equation. Received 15 July 1999; returned for revision 16 September 1999; revised version accepted 14 October 1999 Introduction Excess mortality from cardiovascular disease has been well described in people of south Asian origin living in the UK [1], particularly in those with diabetes mellitus, where routine death certi®cation data sug- gests cardiovascular mortality may be up to three times higher in the south Asians than white Cauca- sians [2]. The burden of cardiovascular disease in the south Asian community may be explicable by a genetic predisposition to insulin resistance, diabetes and the associated metabolic disturbances of other established cardiovascular risk factors such as low HDL cholesterol [1]. Alternatively, there may be an as yet unidenti®ed ethnicity factor which acts inde- pendently of the other conventional risk factors to account for the differences [3]. However, few studies have assessed all cardiovascular risk factors in a quantitative fashion and, unfortunately, no prospec- tive study of the type performed in the white North American population of Framingham [4] has been undertaken in a south Asian population. Correspondence: Dr Frances Game, Department of Diabetes and Endocrinology, Birmingham Heartlands Hospital, Bordesley Green, Birmingham B9 5SS, UK. | OA ã 2000 Blackwell Science Ltd Diabetes, Obesity and Metabolism, 2, 2000, 91±97 | 91