Health inequality between ethnic groups in the United Kingdom is widening. Death rates from coronary heart disease in South Asians (immigrants from India, Pakistan, Bangladesh, and Sri Lanka) have declined at a slower rate than in the indigenous population, while evidence shows that second and third generation South Asians seem to be displaying many of the same risk characteristics that make them prone to coronary heart disease as their parents and grandparents.

Although we still do not have a full explanation for excess deaths from coronary heart disease in South Asians, factors may include higher rates of diabetes, disadvantaged socioeconomic status, high fat diet, and lack of exercise.

Evidence also shows that South Asians are less likely to be prescribed cholesterol lowering drugs and more likely to decline and drop out from cardiac rehabilitation programmes. This may partly be a result of the "attitude of not taking advantage of the health service," lack of awareness of coronary heart disease," and the "linguistic and cultural barriers" seen in this population.

The Department of Health and the British Heart Foundation have played a part in attempting to tackle coronary heart disease among South Asians, including the publication of the national service framework, school fruit and exercise schemes, and funding of community and research projects.

But more needs to be done, say the authors, including better education, aggressive prevention strategies, and more research, and any health services offered need to be appropriate for the culture, religion, and languages of South Asians.

These strategies have become more relevant, considering that the next wave of statistics is likely to mirror the last, they conclude.

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Contact: Emma Dickinson
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BMJ-British Medical Journal
26-May-2005