Groups of immigrants have increased risk of myocardial infarction and stroke

In her PhD thesis, Kjersti Stormark Rabanal has found a high burden of cardiovascular disease among South Asian immigrants, and that the increased risk could not be fully explained by traditional risk factors.


  1. Immigrants from South Asia, Central Asia and Former Yugoslavia have increased risk of cardiovascular disease compared to ethnic Norwegians.
  2. South Asian immigrants have higher risk of cardiovascular disease than Europeans even after controlling for traditional risk factors.
  3. The Framingham risk model is not optimal to predict cardiovascular disease in Europeans.


Thesis: Cardiovascular disease and ethnicity – Focus on the high risk of CVD among South Asians living in Norway and New Zealand
Candidate: Kjersti Stormark Rabanal
Time: February 25 at 12:15
Place: Oslo University Hospital, Ullevål, Laboratory Building: Red Auditorium
Link to university website


(1) Pakistani immigrants in Norway have the highest risk of heart attack. Men and women from South Asia living in Norway have more than doubled risk compared to men and women of Norwegian ethnicity. Furthermore, the risk is increased in persons from Central Asia and Former Yugoslavia, as well as in men from the Middle East. The risk of stroke is also increased in several of the immigrant groups.

The study includes information on all cardiovascular deaths and hospitalizations for cardiovascular disease in persons living in Norway between 1994 and 2009 and aged between 35 and 64.

(2) South Asian immigrants more often have diabetes and an adverse lipid profile than Europeans, which partially explains their increased cardiovascular risk. However, among South Asians there were also fewer smokers and lower blood pressure.

The study includes two different populations: 16,600 persons from Norway and 129,449 persons from New Zealand. Even after adjustment for traditional risk factors, the South Asian immigrants had 40-75 % higher risk of cardiovascular disease compared to Europeans in the two cohorts.

(3) The Framingham model overestimates the risk of cardiovascular disease among European men and women, according to Rabanal’s third paper. The model estimates 5-year risk based on information on age, sex, blood pressure, lipid profile, smoking and diabetes. The study is based on data from more than 250,000 men and women from New Zealand of either Indian or European ethnicity, and the model seems to fit best for Indian men.


(1) Rabanal, K. S., Selmer, R. M., Igland, J., Tell, G. S., & Meyer, H. E. (2015). Ethnic inequalities in acute myocardial infarction and stroke rates in Norway 1994–2009: a nationwide cohort study (CVDNOR)BMC public health15(1), 1073.

(2) Rabanal, K. S., Meyer, H. E., Tell, G. S., Igland, J., Pylypchuk, R., Mehta, S., Kumar, B., Jenum, A. K., Selmer, R. M., & Jackson, R. (2017). Can traditional risk factors explain the higher risk of cardiovascular disease in South Asians compared to Europeans in Norway and New Zealand? Two cohort studiesBMJ open7(12), e016819.

    (3) Rabanal, K. S., Meyer, H. E., Pylypchuk, R., Mehta, S., Selmer, R. M., & Jackson, R. T. (2018). Performance of a Framingham cardiovascular risk model among Indians and Europeans in New Zealand and the role of body mass index and social deprivationOpen heart5(2), e000821.

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