Health: Fear at the heart of a community: Why Asian people in Britain are so vulnerable to heart disease remains a mystery. Mike Johnson investigates

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The dancing was in full swing, and Ashwinbhai Patel was letting go. The wedding reception offered a welcome chance to relax and forget the pressures of business, for one evening at least.

So when he suddenly told fellow guests he felt uncomfortable and needed to sit down, they joked that he couldn't - without him there would be no party.

But minutes later he was dead, the victim of a massive heart attack. He was just 46.

Mr Patel was a respected figure throughout his local community in Wandsworth, southwest London. Young Asian businessmen came to him for advice; they would play cards together every Saturday. But commerce and card games were not all they had in common.

Indian, Pakistani and Bangladeshi people living in England and Wales have a 40 per cent higher than average risk of suffering from coronary heart disease; and diabetes is five times more common among south Asians than Europeans. Curiously, being young poses an even higher relative risk. Asians under 40 are three times more prone to heart disease than the national average.

The problem is proving difficult to understand since the usual risk factors seem not to apply: smoking rates, animal fat intake and blood cholesterol levels are generally lower among the Asian population. This alarming paradox threatens 1.5 million people in this country, and until recently the medical profession has been at a loss to provide answers.

The Government, meanwhile, which first admitted to NHS neglect of this sizeable minority a year ago, is scarcely better informed. In the summer, the Department of Health established an Ethnic Health Unit to ensure that health messages reached ethnic minorities, and some cash support is promised.

The first step must be to find out why Asian people in Britain are so vulnerable. The stress resulting from low incomes and poor housing is believed to be a major factor. But insulin resistance, a disturbance of the body's ability to use carbohydrate as fuel, is thought to be another. This is a particularly common condition within the Asian community.

'Insulin resistance is now thought to be an important cause of coronary heart disease in the general population,' Dr Paul McKeigue, a senior lecturer at the London School of Hygiene and Tropical Medicine, says. 'But it seems to be occurring more commonly in southern Asian people than in the general population.'

Insulin is a hormone that enables muscles to take up glucose to store as fuel. The muscles of insulin-resistant people do not take up glucose in the same way. Researchers believe they take up fat instead and need to produce high levels of insulin to keep their blood glucose levels normal.

These mechanisms in insulin-resistant people are also related to the way they tend to store fat around the midriff. This pattern of depositing fat is itself considered a major risk factor for heart disease.

People who stay thin and physically active are less likely to suffer from insulin resistance, Dr McKeigue says. But it seems that smaller amounts of weight gain among Asian people, compared with the rest of the population, will trigger heart disease.

Dr McKeigue will shortly release the results of a diet and exercise study conducted with the British Heart Foundation among Asians in Southall, west London. His results will offer the first indications whether dieting to lose weight or exercising to keep fit are effective in helping to combat insulin resistance.

The next step will be to translate this into guidance for GPs and health workers. 'Nobody has tested whether community-based dietary intervention is effective for Asian people. So we don't yet have a proper basis for defining health promotion programmes,' he says.

Dr McKeigue has applied to the Government for a research grant from its pounds 1.5m allocation for studies into cardiovascular disease and strokes.

But any research is better than none, says Aruna Thaker, a dietician working exclusively within the Asian community at St George's Hospital, Tooting, south-west London. Mr Patel, who also had diabetes, was referred to her by his GP during the last five months of his life.

'I still can't believe there is so much ignorance about coronary heart disease in the Asian community,' Ms Thaker says. She fears the new initiatives will be too late.

Slowly programmes are beginning to bloom. Bradford Regional Health Authority is seeking two 'heart health' workers to offer advice on diet and exercise to the Bangladeshi community.

'We'll be showing people what a healthy diet might consist of, and making that appropriate to the Bangladeshi community,' Neville Roland, Bradford City Council's health strategy manager, says. 'It's about being able to relate to and get the trust of people in the community.'

Bradford already runs self-help groups, as well as sessions under the Health Education Authority's 'Look After Your Heart' programme, specifically for members of the Asian community, although these are designed primarily to overcome language problems.

'Understanding of heart disease in Asian-origin populations is just starting to unfold,' says Dr Liz Kernohan, director of Bradford University's clinical epidemiology research unit and the city's deputy director of public health. 'We don't want to spread doom and gloom, but within the next year or two it will be obvious to everybody what has been happening.

'Services should be allocated to need. As the need is twice as great in the Asian population, they should get twice as much of everything,' she says.

(Photograph omitted)

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