Southall And Brent REvisited: Cohort profile of SABRE, a UK population-based comparison of cardiovascular disease and diabetes in people of European, Indian Asian and African Caribbean origins

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Abstract
Comparisons of chronic disease in migrant and host populations have provided valuable aetiological insights, and furthered the understanding of balance between genetic and environmental influences on the disease. The UK is home to several migrant groups, the largest and longest established being of Indian Asian and African Caribbean origins. One of the earliest and largest waves of Indian Asian migration to the UK followed the 1947 partition of India. As these migrants reached middle age in the 1970s, it became increasingly apparent, both in the UK and elsewhere overseas, that this population was at greatly increased risk of cardiovascular disease (CVD), both coronary heart disease (CHD) and stroke, compared with host populations.1–6 Initial exploration of conventional risk factors, such as diet, total cholesterol, smoking and blood pressure, showed that these differed markedly between ethnic subgroups and were often more favourable than the host UK population, and therefore these factors could not account for the excess CVD risk observed in all Indian Asian subgroups (such as Indians of Gujarati/Hindu Punjabi/Sikh Punjabi origin, Pakistanis and Bangladeshis). Notably, a greater prevalence of diabetes was found in all Indian Asian subgroups, which linked with the observation of greater fasting hyperinsulinaemia, led us to hypothesize that insulin resistance, associated with upper body fat distribution, could underpin the excess diabetes, hypertriglyceridaemia and CHD in Indian Asians.3 This hypothesis was tested in the Southall study, a large population-based inter-ethnic cross-sectional study of middle-aged men and women carried out between 1988 and 1990.7