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Associations between CVD, diabetes vary by ethnicity
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Longitudinal associations between prediabetes and cardiovascular disease differed significantly in Europeans and South Asians, according to recent findings.
Prediabetes also was linked to the risk for coronary heart disease and CVD in European but not South Asian adults, according to researchers.
In the cohort study, researchers evaluated 1,336 European adults and 1,139 South Asian adults from the SABRE study to determine the link between prediabetes and CVD. Individuals identified for analysis were aged 40 to 69 years at baseline, without prevalent CHD or stroke.
Oral glucose tolerance test or HbA1c were used to determine prediabetes using the International Expert Committee (IEC; HbA1c, 6-6.5%) or American Diabetes Association (HbA1c, 5.7-6.5%) cut-points. New cases of CHD and stroke were determined at 20 years through death certification, hospital admissions, primary care medical record review and participant self-report.
Compared with South Asian participants, IEC-defined prediabetes was linked to the risk for CHD (ethnicity interaction, P = .008) and CVD (ethnicity interaction, P = .04) in European participants. The risk for stroke was linked to IEC-define prediabetes in South Asian participants but not European participants (ethnicity interaction, P = .11).
Among participants with prediabetes at baseline, South Asian participants had higher rates of conversion to overt diabetes compared with European participants (68% vs. 40% for impaired fasting glucose/impaired glucose tolerance; P < .001; 52% vs. 30% for IEC-defined prediabetes; P = .006; and 44% vs. 23% for ADA-defined prediabetes; P < .001).
At follow-up, the researchers found that a lower percentage of European participants with baseline prediabetes compared with South Asian participants with baseline prediabetes who were on lipid lowering medications had a total cholesterol of less than 5 mmol/L or an LDL of less than 3 mmol/L. South Asian participants with baseline diabetes generally had a higher rate of lipid-lowering medication use vs. European participants.
According to the researchers, further study is needed to substantiate these findings and to better understand the mechanism behind these associations.
“Mechanistically, these findings suggest that glycemia may be more related to microvascular than macrovascular disease in South Asians than Europeans,” the researchers wrote. “We have described greater levels of retinal rarefaction, poorer microvascular responses to ischemia, and more adverse cerebral circulatory autoregulation, and others report greater cerebral microvascular disease in South Asians than Europeans, with evidence that the latter two findings were mediated by hyperglycemia.” – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.
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