The risk of ischemic heart disease and stroke among immigrant populations: a systematic review

Background — The increasing frequency of global migration to Canada and other high-income countries has highlighted the need for information on the risk of ischemic heart disease (IHD) and stroke among migrant populations.

Methods — Using the MEDLINE and EMBASE databases, we conducted an English-language literature review of articles published from 2000 to 2014 to study patterns in the incidence of IHD or stroke in migrant populations to high-income countries. Our search revealed 17 articles of interest. All studies stratified immigrants by country or region of birth, except two from Canada and one from Denmark, where all immigrant groups were analyzed together.

Results — The risk of IHD or stroke varied by country-of-origin, country-of-destination, and duration of residence. Our review found that most migrant groups to Western Europe were at a similar or higher risk of IHD and stroke as compared to the host population. Those at a higher risk included many Eastern European, Middle-Eastern, and South Asian immigrants. When duration of residence was considered, it appeared that in most migrants the risk of IHD worsened over time. In contrast, immigrants overall were at lower-risk of both myocardial infarction and stroke in Ontario compared to long-term residents of Canada.

Conclusions — The risks of ischemic heart disease and stroke vary widely in immigrant populations in Western Europe. Detailed studies of immigrants to Canada by country of birth and duration of residence should be undertaken to guide future cardiovascular health promotion initiatives.