A 40.8-year follow-up of 4,754 participants in the SABRE tri-ethnic UK cohort found stark sex-by-ethnicity disparities in coronary heart disease. South Asian males carried the highest cumulative CHD incidence (65% by age 90), but the most striking finding concerns women: South Asian females had 2.44 times the CHD hazard of European females (95% CI: 1.88–3.17), versus only 1.80 times higher risk among South Asian versus European men. The female cardiac protection seen in Europeans — where women had roughly half the CHD hazard of men (HR 0.45) — was substantially eroded in South Asians (HR 0.68) and African/Caribbean participants (HR 0.79). Diabetes, hypercholesterolemia, and hypertriglyceridemia jointly explained the largest population-attributable fractions specifically in South Asian women.
This preprint, not yet peer-reviewed, adds unusually long follow-up data to a body of literature that has systematically underrepresented ethnic minority women in cardiovascular research. The finding that the classic female advantage essentially disappears in South Asian women has direct clinical implications: cardiometabolic screening protocols designed around European female risk profiles likely miss this high-risk group. The cardiometabolic mechanism — particularly insulin resistance-driven dyslipidemia — aligns with established metabolic syndrome literature in South Asian populations, lending biological plausibility. Limitations include the cohort's first-generation migrant design, limiting generalizability to subsequent generations, and baseline risk factors assessed in 1988–91. Still, the 40-year horizon and ethnicity-stratified sex analysis mark this as more than incremental — it reframes female cardiac protection as ethnicity-conditional.
