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Study examines ethnic differences in metabolic risk factors, incident CHD
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CHD-associated morbidity and mortality are elevated in South Asians and lower in African Caribbeans compared with European-origin populations. However, these differences cannot be explained by conventional risk factors measured in midlife, according to data published in the Journal of the American College of Cardiology.
Researchers studied whether ethnic differences in diabetes, dyslipidemia and ectopic fat deposition account for ethnic differences in incident CHD. The study focused on a tri-ethnic community-based cohort from London (SABRE study) examined from 1988 to 1991. CV risk factors were assessed in 2,049 Europeans (24% women), 1,517 South Asians (17% women) and 630 African Caribbeans (45% women). Mean age at baseline was 52.4 years. Primary outcomes of fatal and nonfatal events were recorded during a mean 20.5-year follow-up.
CHD events occurred in 30% of participants.
According to the data, CHD incidence was higher in South Asians and lower in African Caribbeans, compared with Europeans. The age- and sex-adjusted subhazard ratio (SHR) was 1.7 (95% CI, 1.52-1.91) for South Asian vs. European risk, and remained significant after adjustment for waist-to-hip ratio (SHR=1.45; 95% CI, 1.28-1.64). The age- and sex-adjusted SHR was 0.64 (95% CI, 0.52-0.79) for African Caribbean vs. European risk, and remained significant after adjustment for HDL and LDL (SHR=0.74; 95% CI, 0.6-0.92).
At baseline, diabetes was three times more prevalent in South Asians and African Caribbeans compared with Europeans. South Asians were more likely to have central obesity and dyslipidemia and African Caribbeans were less likely to have central obesity and dyslipidemia than Europeans. Stroke was more common in South Asians (adjusted SHR=1.45; 95% CI, 1.17-1.8) and African Caribbeans (adjusted SHR=1.5; 95% CI, 1.13-2.00), compared with Europeans; this differential was more pronounced in participants with diabetes (South Asians: adjusted SHR=1.97; 95% CI, 1.16-3.35; African Caribbeans: adjusted SHR=2.21; 95% CI, 1.14-4.3).
“People of European, South Asian and African Caribbean origin vary markedly in CVD risk, in parallel with differences in metabolic risk factors such as insulin resistance, dyslipidemia and central adiposity. However, the between-ethnic group differences in CVD remained even after adjustment for conventional cardiometabolic risk factors measured in midlife,” the researchers wrote.
“Factors across the life course, in particular the mismatch between early and later life environments in migrant cohorts, may be key. This is of critical importance in lower income countries, where CHD risks are increasing, and in African Caribbean populations, where there is evidence that protection from CHD erodes with time in industrialized environments.”
For more information:
Tillin T. J Am Coll Cardiol. 2013;61:1777-1786.
Disclosure: The researchers report no relevant financial disclosures.