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Can traditional risk factors explain the higher risk of cardiovascular disease in South Asians compared to Europeans in Norway and New Zealand? Two cohort studies.

ABSTRACT: OBJECTIVES:The objective was to prospectively examine potential differences in the risk of first cardiovascular disease (CVD) events between South Asians and Europeans living in Norway and New Zealand, and to investigate whether traditional risk factors could explain any differences. METHODS:We included participants (30-74 years) without prior CVD in a Norwegian (n=16 606) and a New Zealand (n=129?449) cohort. Ethnicity and cardiovascular risk factor information was linked with hospital registry data and cause of death registries to identify subsequent CVD events. We used Cox proportional hazards regression to investigate the relationship between risk factors and subsequent CVD for South Asians and Europeans, and to calculate age-adjusted HRs for CVD in South Asians versus Europeans in the two cohorts separately. We sequentially added the major CVD risk factors (blood pressure, lipids, diabetes and smoking) to study their explanatory role in observed ethnic CVD risk differences. RESULTS:South Asians had higher total cholesterol (TC)/high-density lipoprotein (HDL) ratio and more diabetes at baseline than Europeans, but lower blood pressure and smoking levels. South Asians had increased age-adjusted risk of CVD compared with Europeans (87%-92%?higher in the Norwegian cohort and 42%-75%?higher in the New Zealand cohort) and remained with significantly increased risk after adjusting for all major CVD risk factors. Adjusted HRs for South Asians versus Europeans in the Norwegian cohort were 1.57 (95%?CI 1.19 to 2.07) in men and 1.76 (95%?CI 1.09 to 2.82) in women. Corresponding figures for the New Zealand cohort were 1.64 (95%?CI 1.43 to 1.88) in men and 1.39 (95%?CI 1.11 to 1.73) in women. CONCLUSION:Differences in TC/HDL ratio and diabetes appear to explain some of the excess risk of CVD in South Asians compared with Europeans. Preventing dyslipidaemia and diabetes in South Asians may therefore help reduce their excess risk of CVD.

SUBMITTER: Rabanal KS

PROVIDER: S-EPMC5728264 | biostudies-other | 2017 Dec

REPOSITORIES: biostudies-other

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Can traditional risk factors explain the higher risk of cardiovascular disease in South Asians compared to Europeans in Norway and New Zealand? Two cohort studies.

Rabanal Kjersti S KS Meyer Haakon E HE Tell Grethe S GS Igland Jannicke J Pylypchuk Romana R Mehta Suneela S Kumar Bernadette B Jenum Anne Karen AK Selmer Randi M RM Jackson Rod R

BMJ open 20171206 12

<h4>Objectives</h4>The objective was to prospectively examine potential differences in the risk of first cardiovascular disease (CVD) events between South Asians and Europeans living in Norway and New Zealand, and to investigate whether traditional risk factors could explain any differences.<h4>Methods</h4>We included participants (30-74 years) without prior CVD in a Norwegian (n=16 606) and a New Zealand (n=129 449) cohort. Ethnicity and cardiovascular risk factor information was linked with ho ...[more]

PMID: 29217719

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Project description:BACKGROUND:The pathogenesis and cardiovascular impact of type 2 diabetes (T2D) may be different in South Asians compared with other ethnic groups. The phenotypic characterization of diabetic cardiomyopathy remains debated and little is known regarding differences in T2D-related cardiovascular remodeling across ethnicities. We aimed to characterize the differences in left ventricular (LV) diastolic and systolic function, LV structure, myocardial tissue characteristics and aortic stiffness between T2D patients and controls and to assess the differences in T2D-related cardiovascular remodeling between South Asians and Europeans. METHODS:T2D patients and controls of South Asian and European descent underwent 3 Tesla cardiovascular magnetic resonance imaging (CMR) and cardiac proton-magnetic resonance spectroscopy (1H-MRS). Differences in cardiovascular parameters between T2D patients and controls were examined using ANCOVA and were reported as mean (95% CI). Ethnic group comparisons in the association of T2D with cardiovascular remodeling were made by adding the interaction term between ethnicity and diabetes status to the model. RESULTS:A total of 131 individuals were included (54 South Asians [50.1?±?8.7 years, 33% men, 33 patients vs. 21 controls) and 77 Europeans (58.8?±?7.0 years, 56% men, 48 patients vs. 29 controls)]. The ratio of the transmitral early and late peak filling rate (E/A) was lower in T2D patients compared with controls, in South Asians [-?0.20 (-?0.36; -?0.03), P?=?0.021] and Europeans [-?0.20 (-?0.36; -?0.04), P?=?0.017], whereas global longitudinal strain and aortic pulse wave velocity were similar. South Asian T2D patients had a higher LV mass [+?22 g (15; 30), P?<?0.001] (P for interaction by ethnicity?=?0.005) with a lower extracellular volume fraction [-?1.9% (-?3.4; -?0.4), P?=?0.013] (P for interaction?=?0.114), whilst European T2D patients had a higher myocardial triglyceride content [+?0.59% (0.35; 0.84), P?=?0.001] (P for interaction?=?0.002) than their control group. CONCLUSIONS:Diabetic cardiomyopathy was characterized by impaired LV diastolic function in South Asians and Europeans. Increased LV mass was solely observed among South Asian T2D patients, whereas differences in myocardial triglyceride content between T2D patients and controls were only present in the European cohort. The diabetic cardiomyopathy phenotype may differ between subsets of T2D patients, for example across ethnicities, and tailored strategies for T2D management may be required.

Dataset Information

Can traditional risk factors explain the higher risk of cardiovascular disease in South Asians compared to Europeans in Norway and New Zealand? Two cohort studies.

Publications

Can traditional risk factors explain the higher risk of cardiovascular disease in South Asians compared to Europeans in Norway and New Zealand? Two cohort studies.

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