Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)


Health Research Methodology


Salim Yusuf


Significant differences in the cardiovascular mortality rate exist between Canadians of South Asian, Chinese and European origin. This thesis represents a six year effort to detennine the prevalence of cardiovascular disease, the burden of atherosclerosis, and the prevalence of their major determinants among three ethnic groups in Canada. In addition to the study of the relationship of the "classical" cardiovascular risk factors to disease outcomes, the contribution to disease outcomes of selected "emerging" risk factors (e.g. markers of thrombosis, socio-economic, dietary, and psychosocial stress factors) was studied.

The major findings reported in this thesis include the confirmation that South Asians in Canada have the greatest prevalence, Europeans have an intermediate prevalence, and the Chinese have the lowest prevalence of cardiovascular disease. However, Europeans have significantly more atherosclerosis compared to the South Asians and Chinese. Yet, for any given amount of atherosclerosis, South Asians suffer more cardiovascular events. This may reflect an increased propensity of South Asians to develop arterial thrombosis.

Major differences in the daily calorie consumption, and in the sources of calories exist between the ethnic groups. Diet was measured using food frequency questionnaires developed for each ethnic group, which were found to reliably classify individuals into high or low consumers for a given macronutrient. This classification facilitates the study of diet-disease relationships.

Psychosocial stress was measured in a valid and reliable way using a single questionnaire created for use by all participants. Discrimination in the workplace is a challenge to measure, and while it was reported more often among South Asians and Chinese, its reproducibility was relatively low. Markers of social stability (e.g. income and employment) were associated with psychosocial stress factors, neurohormones, atherosclerosis and cardiovascular disease. This demonstrates the powerful influence that "social factors" have on the health of free-living Canadians.

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