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A prospective survey has been undertaken of a total community of 1343 men and 1149 women, aged 35-69 years at recruitment, living in Port-of-Spain, Trinidad. By comparison with adults of African descent, age-adjusted relative risks of death from all causes and from cardiovascular diseases were significantly increased in those of Indian origin (1·5 and 2·6, respectively) and reduced in those of mixed descent (0·5 and 0·3, respectively). Adults of European descent had an all-cause and cardiovascular mortality relative risk of 0·8 and 2·1, respectively. These ethnic differences in risk were not explained by systolic blood pressure, fasting blood glucose concentration, serum high-density lipoprotein or low-density lipoprotein concentration, or smoking habits. Differences in risk of cardiovascular death between Indian and European men seemed to be accounted for by the high prevalence of diabetes in Indians (19%) but other ethnic contrasts in mortality were unrelated to diabetes mellitus.

Prevalence of coronary heart disease (CHD) and fasting serum lipoprotein concentrations in ethnic groups in Port of Spain, Trinidad, were compared. In a total community survey of 1416 men aged 35-69 years, angina pectoris, a history of possible myocardial infarction, and major Q waves on the electrocardiogram were significantly more common in men of Indian descent than in other ethnic groups (relative risk about 3/1). Indians had significantly lower high-density-lipoprotein-cholesterol (HDL Ch ) concentrations and significantly higher low-density-lipoprotein-cholesterol (LDL Ch ) concentrations than other groups. After allowance for age and ethnic group, men with major Q waves or a history of possible myocardial infarction had a significantly greater ratio of LDL Ch /HDL Ch than men without either. Comparison of surveys in the Caribbean suggests that in this region CHD is prevalent only in communities in which a sizeable proportion of men have an LDL Ch /HDL Ch ratio greater than 6 and an LDL Ch concentration above 5 mmol/l.

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