• Queen Mary University of London
  • Barts Health NHS

Diabetes and heart disease in Bangladeshis and Pakistanis

People in East London have some of the worst health in England, for example:

  • Pakistani men have the highest rate of heart disease in UK.
  • The risk of South Asian women dying early from heart disease is 65% higher than the general population.
  • British-Bangladeshi and -Pakistani people are five or six times more likely to have type 2 diabetes than the general population.
  • Newham and Tower Hamlets have the lowest life expectancy of all London Boroughs.
  • Newham and Tower Hamlets have the highest circulatory disease death rates in London.
  • At birth, males and females in Richmond upon Thames can expect to live without a disability for more than 13 years longer than those in Newham.

Why are some health conditions more common in Bangladeshi and Pakistani people?

All of the reasons for the high levels of ill-health from diabetes and heart disease haven't yet been precisely worked out. However, we already know some of the differences in health are likely to arise from the combined effects of many factors, including genetic variation, socio-economic differences (affecting poverty, nutrition and housing conditions), and differences in social and cultural beliefs and lifestyle practices (e.g. differences in diet/food habits, in taking exercise, and in treatment-seeking behaviour).

What can be done about this?

It's important for East London Bangladeshi and Pakistani communities and their healthcare providers to be aware of these issues. You can do already something yourself by stopping smoking, eating a healthier diet, taking more exercise, and having your blood pressure, glucose levels (or a test called haemoglobin A1C) and cholesterol levels checked (and treated if necessary)!

There is also a need for more research in order to work out in greater detail why individuals of Bangladeshi and Pakistani heritage are particularly affected in this way. For instance, are there links between your genetic make-up and risks of disease?

Our East London Genes & Health study aims to help researchers to find out more, for example by looking at the health history of individuals with variants in genes to find out if there is any link between the gene and disease, or in response to treatments.


 

Diabetes

Most people know that diabetes has something to do with sugar and insulin, but many are unaware that there are actually two main types of diabetes – type 1 and type 2. Although there are similarities, these two are actually quite different conditions in terms of how they develop and are managed.

Insulin is a hormone that is produced by a gland called the pancreas (which sits just behind the stomach). When we eat carbohydrates, these are broken down into a number of sugars – one of which is glucose. Insulin’s role is to control the amount of glucose we have in our blood; too much glucose in the bloodstream can have serious effects on various organs and tissues, including the eyes, kidney and heart.

Type 1 diabetes typically develops early in life, often during teenage years. In this type of diabetes the body’s immune system destroys insulin-producing cells. As a result, people with type 1 diabetes need life-long insulin injections.

In type 2 diabetes, the body doesn't produce enough insulin, or the body's cells don't react to insulin. This type of diabetes is more common in the UK, but often symptoms can be controlled with good diet and exercise and regular monitoring of blood glucose levels. However, the disease is progressive, which means it can get worse and require treatment in the form of tablets or insulin injections. Type 2 diabetes is associated with obesity, so maintenance of a healthy weight can help control or prevent the condition.

For more information about diabetes: http://www.nhs.uk/Conditions/Diabetes/Pages/Diabetes.aspx#close


 

Heart disease

Rather than being heart-shaped, the heart is in fact a fist-size organ that is responsible for pumping blood around our bodies via an intricate network of blood vessels. These include arteries (that lead away from the heart, generally carrying blood rich in oxygen to the body) and veins (that lead towards the heart, generally carrying blood low in oxygen) and capillaries (small blood vessels that join arteries and veins together). The heart is made up of chambers with valves that help the heart carry out its pumping action. Importantly, the heart gets its own blood supply via blood vessels called the coronary arteries.

Coronary heart disease (CHD), which is the leading cause of death both in the UK and worldwide, can result in heart failure, heart attacks, and more commonly, angina (chest pain related to exercise). It usually is the result of a build up of fatty substances such as cholesterol in the coronary arteries (atherosclerosis) that affect or block the heart’s blood supply. Atherosclerosis is associated with:

  • smoking
  • high cholesterol levels
  • high blood pressure (hypertension)
  • diabetes

A heart attack (also known as myocardial infarction or MI) arises when blood flow to the heart is suddenly disrupted, causing damage to heart muscle. It usually causes chest pain and other symptoms such as shortness of breath, sweating and vomiting. In some cases an individual may have a silent heart attack – with vague or very few symptoms.

Cardiac arrest is when the heart actually stops pumping completely; it’s different from a heart attack, although it may result from such an attack.

Angina is chest pain that usually occurs during activity or exercise and is the result of a reduced heart blood supply fue to narrowed heart arteries. It usually happens because the arteries supplying the heart have become hardened and narrowed due to atherosclerosis. Some people may experience a squeezing discomfort or pressure rather than any actual pain.

 Key ways to prevent heart disease are:

  • eating a healthy, balanced, low-fat, high-fibre diet
  • increasing physically activity and maintaining a healthy weight
  • giving up smoking
  • reducing alcohol consumption
  • keeping blood pressure under control
  • keeping any diabetes under control
  • taking prescribed medications as directed by your doctor – especially if these were prescribed to prevent heart-related illness

 

For more information about heart disease and its prevention:

http://www.nhs.uk/Conditions/Coronary-heart-disease/Pages/Introduction.aspx

http://www.nhs.uk/Conditions/Coronary-heart-disease/Pages/Prevention.aspx


 

References:

Office for National Statistics, 2008-10; http://www.ons.gov.uk/ons/rel/disability-and-health-measurement/sub-nati...

Ethnic Differences in Cardiovascular Disease 2010 edition. British Heart Foundation. https://www.bhf.org.uk/publications/statistics/ethnic-differences-in-car...

The Health of the Population. NorthEast London Commissioning Support Unit. 2014. http://www.transformingservices.org.uk/interim-case-for-change.htm

Coronary heart disease statistics: diabetes supplement. 2001 edition. British Heart Foundation. https://www.bhf.org.uk/publications/statistics/coronary-heart-disease-st...

It is worth noting that people in the East London Bangladeshi community are on average younger than some other populations in the UK. It's therefore important to age-standardise to make a fair comparison of rates of disease between populations.

 

Written by Julie N Reza and David van Heel, with advice from Tahseen Chowdhury and Andrew Wragg.