The Role of Diabetes and Components of the Metabolic Syndrome in Stroke and Coronary Heart Disease Mortality in U.K. White and African-Caribbean Populations

• CHD, coronary heart disease
• HOMA, homeostasis model assessment

Foreign-born African Americans have low coronary heart disease (CHD) mortality rates, whereas those born in the U.S. have elevated rates compared with the white population (1–3). In U.K. African-Caribbean men (mainly first-generation migrants) the rate is half that of the general population (4). As in the U.S., U.K. African Caribbeans are predisposed to hypertension, diabetes, and insulin resistance, while triglyceride levels are substantially lower than in Europeans (5–8). U.K. African-Caribbean men are also less centrally obese than European men. These latter factors may contribute to the relative protection from CHD in U.K. African Caribbeans. However, confirmatory data from U.K.-specific cohorts are required. Higher risk of stroke in U.K. African Caribbeans may not be explicable by elevated resting blood pressure, as we have previously found that resting systolic blood pressure is only 6 mmHg higher in African-Caribbean men compared with European men (9).

We describe CHD and stroke mortality rates in U.K. African Caribbeans and Europeans and investigate whether ethnic group differences can be explained by differences in diabetes or other conventional cardiovascular risk factors.