Epidemic of Cardiovascular Disease and Diabetes: Explaining the Phenomenon in South Asians Worldwide 1st Edition (2019) (PDF) by Raj S. Bhopal

Description

In people with South Asian ancestry, the cardiovascular diseases of stroke and coronary heart disease (CVD) are epidemic, and type 2 diabetes mellitus (DM2) is pandemic. As South Asians comprise about 25% of the world’s population their high susceptibility is of global public health and clinical importance. Eluding researchers across the globe, this phenomenon continues to be a subject of intensive enquiry.

As Ban Ki-moon, the United Nations Secretary-General, points out, the epidemics of chronic diseases, which he describes as a public health emergency in slow motion, can be restrained but not stopped. With a focus on the global South Asian population, Epidemic of Cardiovascular Disease and Diabetes: Explaining the Phenomenon in South Asians Worldwide is a critical review of current literature investigating the increase in cases of CVD and DM2, and the data underpinning them. The book argues that the high risk of CVD and DM2 in urbanised South Asians is not inevitable, genetic, or programmed in a fixed way. Rather, exposure to risk factors in childhood, adolescence, and most particularly in adulthood, is the key to unravelling its cause.

User’s Reviews

Review “This is a commendable book packed with vignettes and a must read for all researchers and epidemiologists pursuing various theories as well as those contemplating research on the topic.” — Enas A. Enas MD, FACC, Executive Director, Coronary Artery Disease in Indians (CADI) Research Foundation”This book is a thoughtful and useful addition to my reading list as a teacher of nursing, health care and research. It provides researchers and health-care practitioners with a strong foundation upon which to begin to think about race, ethnicity, multiculturalism and health care. This will be auseful textbook for health-care and research students at the postgraduate level[.]” — Helen Therese Allan, World Health Organisation

Reviews from Amazon users, collected at the time the book is getting published on UniedVRG. It can be related to shiping or paper quality instead of the book content:

⭐ This is a meticulously researched analysis of the various hypotheses and postulates which attempt to account for the higher than expected rates of cardiovascular disease (CVD) and Type 2 diabetes (DM) in South Asians in urban areas. The term South Asians refers predominantly to people from India, Pakistan and Bangladesh. In the UK comparisons are made with “White Europeans” which may itself encompass a wide range of backgrounds and in South Asia with urban and rural samples.The major puzzle is that South Asians are more prone to CVD and DM when some of the proposed risk fractors are no worse and, sometimes, lower than in White Europeans.Thus either they are more susceptible to the proposed risk factors, have greater exposure, or the risk factors, as usually defined, are less applicable.Professor Bhopal explores past and current lines of research including genetic factors in relation to, for example, body shape and a tendency to central fat. South Asians end to be of low birthweight with, sometimes, poor nutrition early in life followed by rapid weight gain with greater affluence which has implications for the underlying biochemistry. The “thrifty hypothesis” is considered. This posits that a rural life has more physical activity and simple food. A move to urban life, wherever it is, tends to bring a more sedentary way of life and the availability of a wider range of foods some of which are processed and high in salt and sugar. Although CVD and DM have been described in earlier times they are predomnantly modern diseases which also afflict large numbers of people in the Western world. Indeed it could be argued that contemporary humans are not built for the behaviour and environment they are now experiencing, pollution of air, water and food, stressful lives and lack of physical exercise exacerbated by electronic devices such as TV and smartphones.The search for explanatory factors includes hypertension, lipids, tobacco use, hyperglycaemia, thyroid function, vitamins D and B12, inflammation, the anatomy of the circulatory system, infections, high heat cooking, co-morbidities and psychosocial factors. All these are carefully examined for their explanatory weight. The author alludes to but does not elaborate on the fact that the problem with risk factors is that some have been more rigorously tested than others, some may be overemphasised simply because of the sheer volume of work that has been done in a certain area and assumed to be important, what have been called “accepted facts” which later prove unacceptable. Most epidemiological research is based upon the association of variables, whilst controlling for other factors. As Professor Bhopal notes this can be a problem where conclusions tend to outgrow the strength of the data. Samples may be small and unrepresentative. He wrily comments that a search for multiple causes may be misguided as in the case of gastric ulcer where helicobacter pylori, was found to be the culprit.Although this book was intended to be relatively easy for any interested reader I fear that this is not necessarily the case. In some places the arguments are very complex and, in spite of a welcome glossary of medical terms and acronyms, it would be helpful for the reader to have some aquaintance with biochemistry, medicine and epidemiology. In some places it is not crystal clear whether the topic under discussion is CVD or DM, although they are, of course related.The figures and charts are very helpful in simplifying possible causative pathways and they are easy to understand.Professor Bhopal is very open minded and urges more independence of thought in both medics and researchers and a more critical approach to hypotheses which can undeservedly be elevated to accepted facts. He also suggests more rigorous public health action such as improved food policy at govermental level comparable to that taken with respect to smoking. It should be possible, for example, to impose controls on levels of salt and sugar in processed food.Overall, this is a very important and necessary book and, although a difficult read in parts, one is left with, not solely a more comprehensive knowledge of the research in this field but also an enhanced awareness of the critical stance required when considering the various explanations under consideration. Professor Bhopal has an admirable willingness to point to the problems and pitfalls of research whilst indicating the most promising directions of investigation.I recommend this book to medical and nursing students, epidemiolgists, physicians, other health professionals, social scientists and informed lay persons.Dr Sonja M Hunt

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