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Journal of Public Health Advance Access originally published online on December 3, 2008
Journal of Public Health 2009 31(1):168-174; doi:10.1093/pubmed/fdn099
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© The Author 2008, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved

Ethnic differences in long-term improvement of angina following revascularization or medical management: a comparison between south Asians and white Europeans



M. Justin Zaman, Clinical Research Fellow1

Angela M. Crook, Research Fellow in Medical Statistics1

Cornelia Junghans, Research Fellow in Epidemiology1

Natalie K. Fitzpatrick, Research and Development Programme Manager1

Gene Feder, Professor of Primary Care Research and Development2

Adam D. Timmis, Professor of Clinical Cardiology2

Harry Hemingway, Professor of Clinical Epidemiology1
1 Clinical Epidemiology Group, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
2 Queen Mary's School of Medicine and Dentistry, University of London, London E1 4NS, UK

Address correspondence to M. Justin Zaman, E-mail: j.zaman{at}ucl.ac.uk


  Abstract

Background It is not known whether there are disparities in morbidity outcomes between south Asians and whites with established coronary disease.

Methods Six-year prospective cohort study to determine whether improvement of angina symptoms differs between 196 south Asians and 1508 whites following revascularization or medical management.

Results 43.9% of south Asians reported improvement in angina at 6 years compared with 60.3% of whites (age-adjusted OR 0.56, 95% CI 0.41–0.76, adjusted for diabetes, hypertension, smoking, number of diseased vessels, left ventricular function and social class OR 0.59, 95% CI 0.41–0.85). Similar proportions of whites and south Asians underwent percutaneous coronary intervention (PCI) (19.6% versus 19.9%) and coronary artery bypass surgery (CABG) (32.8% versus 30.1%). South Asians were less likely to report improved angina after PCI (OR 0.19, 95% CI 0.06–0.56) or CABG (OR 0.36, 95% CI 0.17–0.74). There was less evidence of ethnic differences in angina improvement when treatment was medical (OR 0.87, 95% CI 0.48–1.57).

Conclusion South Asians were less likely to experience long-term improvements in angina than whites after receipt of revascularization. Further research is needed to identify why these ethnic groups differ in symptomatic prognosis following revascularization for coronary disease and how these differences may be mitigated.

Keywords: ethnicity, prognosis, South Asian, stable angina


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