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.

Contact: Sandeep Gupta, Consultant Cardiologist, Whipps Cross University Hospital, London, UK Tel (mobile): +44 (0)7961 379 928 or (via secretary): +44 (0)20 8504 6121 Email: sgupta111aol

Click here to view full paper

bmj

Leishmania parasites are protozoans which are spread by a mosquito-like sandfly. They affect about 12 million people a year causing two main forms of disease “ cutaneous (sores on the skin), and visceral (enlarged spleens and livers).

Instead of storing glucose as carbohydrates like starch or glycogen, as higher plants and animals do, leishmanias store another sugar, mannose, in a form known as mannan. The researchers believe mannan is essential to the parasite ™s ability to survive in the human body and are studying how it is formed.

Mannose is also an important component in the structure of the cell wall of the tuberculosis bacterium. TB is the world ™s major cause of bacterial death, the leading killer of women of childbearing age, and the eventual cause of one in three deaths from HIV. The bacterium ™s cell wall forms a barrier to drugs, making it difficult to treat.

Associate Professor McConville, Dr Williams, and others are investigating how the wall is built and are seeking ways of disrupting the process.

Already they have discovered that the enzymes involved in mannan biosynthesis are novel and thus are promising drug targets.

unimelb.au