Greater susceptibility

Proposed mechanisms include:

• genetic differences (as yet unidentified)
  
  
• mismatch between a fetal/early life metabolism and that in middle age
  
  
• rapid change in some risk factors that may confer risk e.g. Punjabis in Southall had a mean serum cholesterol of 6.5 mmol/l compared with 4.9 mmol/l for their siblings in Punjab, India. By inference, migration had led to a rise in cholesterol by 1.6 mmol/l. This rapid rise in a risk factor for ischaemic heart disease could be very important (1)

Reference:

• British Heart Foundation (2000), Factfile 4/2000.