TY - JOUR
T1 - The Relationship Between Metabolic Risk Factors and Incident Cardiovascular Disease in Europeans, South Asians, and African Caribbeans SABRE (Southall and Brent Revisited)-A Prospective Population-Based Study
T2 - SABRE (Southall and Brent Revisited) -a prospective population-based study
AU - Tillin, Therese
AU - Hughes, Alun D.
AU - Mayet, Jamil
AU - Whincup, Peter
AU - Sattar, Naveed
AU - Forouhi, Nita G.
AU - McKeigue, Paul M.
AU - Chaturvedi, Nish
N1 - The study was funded at baseline by the Medical Research Council, Diabetes UK, and British Heart Foundation and at follow-up by the Wellcome Trust and British Heart Foundation.
PY - 2013/4/30
Y1 - 2013/4/30
N2 - Objectives This study sought to determine whether ethnic differences in diabetes, dyslipidemia, and ectopic fat deposition account for ethnic differences in incident cardiovascular disease.Background Coronary heart disease risks are elevated in South Asians and are lower in African Caribbeans compared with Europeans. These ethnic differences map to lipid patterns and ectopic fat deposition.Methods Cardiovascular risk factors were assessed in 2,049 Europeans, 1,517 South Asians, and 630 African Caribbeans from 1988 through 1991 (mean age: 52.4 +/- 6.9 years). Fatal and nonfatal events were captured over a median 20.5-year follow-up. Subhazard ratios (SHR) were calculated using competing risks regression.Results Baseline diabetes prevalence was more than 3 times greater in South Asians and African Caribbeans than in Europeans. South Asians were more and African Caribbeans were less centrally obese and dyslipidemic than Europeans. Compared with Europeans, coronary heart disease incidence was greater in South Asians and less in African Caribbeans. The age-and sex-adjusted South Asian versus European SHR was 1.70 (95% confidence interval [CI]: 1.52 to 1.91, p <0.001) and remained significant (1.45, 95% CI: 1.28 to 1.64, p <0.001) when adjusted for waist-to-hip ratio. The African Caribbean versus European age-and sex-adjusted SHR of 0.64 (95% CI: 0.52 to 0.79, p <0.001) remained significant when adjusted for high-density lipoprotein and low-density lipoprotein cholesterol (0.74, 95% CI: 0.60 to 0.92, p = 0.008). Compared with Europeans, South Asians and African Caribbeans experienced more strokes (age-and sex-adjusted SHR: 1.45 [95% CI: 1.17 to 1.80, p = 0.001] and 1.50 [95% CI: 1.13 to 2.00, p = 0.005], respectively), and this differential was more marked in those with diabetes (age-adjusted SHR: 1.97 [95% CI: 1.16 to 3.35, p = 0.038 for interaction] and 2.21 [95% CI: 1.14 to 4.30, p = 0.019 for interaction]).Conclusions Ethnic differences in measured metabolic risk factors did not explain differences in coronary heart disease incidence. The apparently greater association between diabetes and stroke risk in South Asians and African Caribbeans compared with Europeans merits further study. (J Am Coll Cardiol 2013;61:1777-86) (C) 2013 by the American College of Cardiology Foundation
AB - Objectives This study sought to determine whether ethnic differences in diabetes, dyslipidemia, and ectopic fat deposition account for ethnic differences in incident cardiovascular disease.Background Coronary heart disease risks are elevated in South Asians and are lower in African Caribbeans compared with Europeans. These ethnic differences map to lipid patterns and ectopic fat deposition.Methods Cardiovascular risk factors were assessed in 2,049 Europeans, 1,517 South Asians, and 630 African Caribbeans from 1988 through 1991 (mean age: 52.4 +/- 6.9 years). Fatal and nonfatal events were captured over a median 20.5-year follow-up. Subhazard ratios (SHR) were calculated using competing risks regression.Results Baseline diabetes prevalence was more than 3 times greater in South Asians and African Caribbeans than in Europeans. South Asians were more and African Caribbeans were less centrally obese and dyslipidemic than Europeans. Compared with Europeans, coronary heart disease incidence was greater in South Asians and less in African Caribbeans. The age-and sex-adjusted South Asian versus European SHR was 1.70 (95% confidence interval [CI]: 1.52 to 1.91, p <0.001) and remained significant (1.45, 95% CI: 1.28 to 1.64, p <0.001) when adjusted for waist-to-hip ratio. The African Caribbean versus European age-and sex-adjusted SHR of 0.64 (95% CI: 0.52 to 0.79, p <0.001) remained significant when adjusted for high-density lipoprotein and low-density lipoprotein cholesterol (0.74, 95% CI: 0.60 to 0.92, p = 0.008). Compared with Europeans, South Asians and African Caribbeans experienced more strokes (age-and sex-adjusted SHR: 1.45 [95% CI: 1.17 to 1.80, p = 0.001] and 1.50 [95% CI: 1.13 to 2.00, p = 0.005], respectively), and this differential was more marked in those with diabetes (age-adjusted SHR: 1.97 [95% CI: 1.16 to 3.35, p = 0.038 for interaction] and 2.21 [95% CI: 1.14 to 4.30, p = 0.019 for interaction]).Conclusions Ethnic differences in measured metabolic risk factors did not explain differences in coronary heart disease incidence. The apparently greater association between diabetes and stroke risk in South Asians and African Caribbeans compared with Europeans merits further study. (J Am Coll Cardiol 2013;61:1777-86) (C) 2013 by the American College of Cardiology Foundation
KW - MYOCARDIAL-INFARCTION
KW - BLOOD-PRESSURE
KW - STROKE
KW - UK
KW - INDIVIDUALS
KW - ETHNICITY
KW - COUNTRIES
KW - stroke
KW - coronary heart disease
KW - MORTALITY
KW - incidence
KW - EPIDEMIOLOGY
KW - ethnicity
KW - CORONARY-HEART-DISEASE
U2 - 10.1016/j.jacc.2012.12.046
DO - 10.1016/j.jacc.2012.12.046
M3 - Article
C2 - 23500273
SN - 0735-1097
VL - 61
SP - 1777
EP - 1786
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 17
ER -