Circulating Haemoglobin Levels and the Risk of Atherosclerosis in Asian Indian Populations

Jeetesh V. Patel,1,2,3 Paul J. Flinders,3 Avni Vyas,1 Imogen Glover,3  Avithra J. Rajan,3 Dorairaj Prabhakaran,4 Deepak Bhatnagar,1  K. Srinath Reddy,4 Michael I. Mackness,1 J. Kennedy Cruickshank,1  Elizabeth A. Hughes,2 Paul N. Durrington1

1. Clinical Epidemiology & Cardiovascular Medicine Group, University Department of Medicine,  University of Manchester, Manchester, UK
2. Sandwell Medical Research Unit, Sandwell and West Birmingham Hospitals NHS Trust,  West Bromwich, UK
3. School of Medicine, University of Nottingham, Nottingham, UK
4. Department of Cardiology, All India Institute of Medical Sciences, Delhi, India
*Correspondence to

Disclosure: No potential conflicts of interest.
Received: 05.12.14 Accepted: 12.01.15
Citation: EMJ Cardiol. 2015;3[1]:58-66.


Background: The global burden of coronary heart disease (CHD) is estimated to be the highest on the Indian subcontinent. The pathophysiology of this increased risk is complex, multifactorial, and its  magnitude increases with migration from India to Britain. Haemoglobin disorders, which also frequent  this ethnic group, have been linked to cardiovascular disease. We investigated the impact of migration  and nutritional intake on haematological parameters amongst South Asians, with a focus on their  relation to molecular indices of oxidative atherogenesis.
Methods: Haematology, diet, oxidised low-density lipoprotein (LDL), and serum paraoxonase activity were measured in 230 migrant Indian Gujaratis (Britain), and 305 matched contemporaries living in rural  villages (India).
Results: Median levels of haemoglobin were higher amongst migrant men (14.5 µmol/l) compared to  rural men (15.0 µmol/l, P=0.004) and higher in migrant women (12.7 µmol/l) compared to rural women  (11.8 µmol/l, P<0.001). Irrespective of site, haemoglobin levels in South Asians were positively associated  with high blood pressure, high serum cholesterol, low high density lipoprotein (HDL) cholesterol levels, and increased CHD risk scores (P<0.001). Haemoglobin concentrations were higher amongst  migrants compared to rural contemporaries (P<0.001). In rural women, red cell volume was lower,  and co-ordinated with lower levels of oxidised LDL compared with migrant women (P<0.001). On  multivariate analysis, haemoglobin was independently associated with oxidised LDL (P=0.001) and paraoxonase activity (P=0.025).
Conclusion: Levels of haemoglobin were independently associated with indices of atherogenesis in our populations of rural and migrant Indians. Iron availability may underline the pathogenesis for the  oxidative modification of LDL in this group.

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