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Ethnicity Modifies Associations between Cardiovascular Risk Factors and Disease Severity in Parallel Dutch and Singapore Coronary Cohorts.

Gijsberts CM, Seneviratna A, de Carvalho LP, den Ruijter HM, Vidanapthirana P, Sorokin V, Stella P, Agostoni P, Asselbergs FW, Richards AM, Low AF, Lee CH, Tan HC, Hoefer IE, Pasterkamp G, de Kleijn DP, Chan MY - PLoS ONE (2015)

Bottom Line: We found distinct inter-ethnic differences in cardiovascular risk factors.Chinese (OR 1.3 [1.1-1.7], p = 0.008) and Malay (OR 1.9 [1.4-2.6], p<0.001) ethnicity were independently associated with more severe CAD as compared to White ethnicity.Strikingly, when stratified for diabetes status, we found a significant association of all three Asian ethnic groups as compared to White ethnicity with more severe CAD among diabetics, but not in non-diabetics.

View Article: PubMed Central - PubMed

Affiliation: Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands; The Netherlands Heart Institute (ICIN), Utrecht, The Netherlands.

ABSTRACT

Background: In 2020 the largest number of patients with coronary artery disease (CAD) will be found in Asia. Published epidemiological and clinical reports are overwhelmingly derived from western (White) cohorts and data from Asia are scant. We compared CAD severity and all-cause mortality among 4 of the world's most populous ethnicities: Whites, Chinese, Indians and Malays.

Methods: The UNIted CORoNary cohort (UNICORN) simultaneously enrolled parallel populations of consecutive patients undergoing coronary angiography or intervention for suspected CAD in the Netherlands and Singapore. Using multivariable ordinal regression, we investigated the independent association of ethnicity with CAD severity and interactions between risk factors and ethnicity on CAD severity. Also, we compared all-cause mortality among the ethnic groups using multivariable Cox regression analysis.

Results: We included 1,759 White, 685 Chinese, 201 Indian and 224 Malay patients undergoing coronary angiography. We found distinct inter-ethnic differences in cardiovascular risk factors. Furthermore, the associations of gender and diabetes with severity of CAD were significantly stronger in Chinese than Whites. Chinese (OR 1.3 [1.1-1.7], p = 0.008) and Malay (OR 1.9 [1.4-2.6], p<0.001) ethnicity were independently associated with more severe CAD as compared to White ethnicity. Strikingly, when stratified for diabetes status, we found a significant association of all three Asian ethnic groups as compared to White ethnicity with more severe CAD among diabetics, but not in non-diabetics. Crude all-cause mortality did not differ, but when adjusted for covariates mortality was higher in Malays than the other ethnic groups.

Conclusion: In this population of individuals undergoing coronary angiography, ethnicity is independently associated with the severity of CAD and modifies the strength of association between certain risk factors and CAD severity. Furthermore, mortality differs among ethnic groups. Our data provide insight in inter-ethnic differences in CAD risk factors, CAD severity and mortality.

No MeSH data available.


Related in: MedlinePlus

Severity of CAD by ethnicity.Bar chart depicting the distribution of CAD severity as the percentage of the total number of individuals per ethnic group. Triple vessel disease is significantly more common among Chinese, Indians and Malays than among Whites (p <0.001).
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pone.0132278.g001: Severity of CAD by ethnicity.Bar chart depicting the distribution of CAD severity as the percentage of the total number of individuals per ethnic group. Triple vessel disease is significantly more common among Chinese, Indians and Malays than among Whites (p <0.001).

Mentions: The prevalence of triple vessel disease was strikingly high in Malays (31.6%), followed by Chinese with a prevalence of 23.8% and 23.2% in Indians, as compared to Whites (14.0%, p<0.001). The distribution of the severity of CAD among the ethnic groups is depicted in Fig 1.


Ethnicity Modifies Associations between Cardiovascular Risk Factors and Disease Severity in Parallel Dutch and Singapore Coronary Cohorts.

Gijsberts CM, Seneviratna A, de Carvalho LP, den Ruijter HM, Vidanapthirana P, Sorokin V, Stella P, Agostoni P, Asselbergs FW, Richards AM, Low AF, Lee CH, Tan HC, Hoefer IE, Pasterkamp G, de Kleijn DP, Chan MY - PLoS ONE (2015)

Severity of CAD by ethnicity.Bar chart depicting the distribution of CAD severity as the percentage of the total number of individuals per ethnic group. Triple vessel disease is significantly more common among Chinese, Indians and Malays than among Whites (p <0.001).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4492665&req=5

pone.0132278.g001: Severity of CAD by ethnicity.Bar chart depicting the distribution of CAD severity as the percentage of the total number of individuals per ethnic group. Triple vessel disease is significantly more common among Chinese, Indians and Malays than among Whites (p <0.001).
Mentions: The prevalence of triple vessel disease was strikingly high in Malays (31.6%), followed by Chinese with a prevalence of 23.8% and 23.2% in Indians, as compared to Whites (14.0%, p<0.001). The distribution of the severity of CAD among the ethnic groups is depicted in Fig 1.

Bottom Line: We found distinct inter-ethnic differences in cardiovascular risk factors.Chinese (OR 1.3 [1.1-1.7], p = 0.008) and Malay (OR 1.9 [1.4-2.6], p<0.001) ethnicity were independently associated with more severe CAD as compared to White ethnicity.Strikingly, when stratified for diabetes status, we found a significant association of all three Asian ethnic groups as compared to White ethnicity with more severe CAD among diabetics, but not in non-diabetics.

View Article: PubMed Central - PubMed

Affiliation: Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands; The Netherlands Heart Institute (ICIN), Utrecht, The Netherlands.

ABSTRACT

Background: In 2020 the largest number of patients with coronary artery disease (CAD) will be found in Asia. Published epidemiological and clinical reports are overwhelmingly derived from western (White) cohorts and data from Asia are scant. We compared CAD severity and all-cause mortality among 4 of the world's most populous ethnicities: Whites, Chinese, Indians and Malays.

Methods: The UNIted CORoNary cohort (UNICORN) simultaneously enrolled parallel populations of consecutive patients undergoing coronary angiography or intervention for suspected CAD in the Netherlands and Singapore. Using multivariable ordinal regression, we investigated the independent association of ethnicity with CAD severity and interactions between risk factors and ethnicity on CAD severity. Also, we compared all-cause mortality among the ethnic groups using multivariable Cox regression analysis.

Results: We included 1,759 White, 685 Chinese, 201 Indian and 224 Malay patients undergoing coronary angiography. We found distinct inter-ethnic differences in cardiovascular risk factors. Furthermore, the associations of gender and diabetes with severity of CAD were significantly stronger in Chinese than Whites. Chinese (OR 1.3 [1.1-1.7], p = 0.008) and Malay (OR 1.9 [1.4-2.6], p<0.001) ethnicity were independently associated with more severe CAD as compared to White ethnicity. Strikingly, when stratified for diabetes status, we found a significant association of all three Asian ethnic groups as compared to White ethnicity with more severe CAD among diabetics, but not in non-diabetics. Crude all-cause mortality did not differ, but when adjusted for covariates mortality was higher in Malays than the other ethnic groups.

Conclusion: In this population of individuals undergoing coronary angiography, ethnicity is independently associated with the severity of CAD and modifies the strength of association between certain risk factors and CAD severity. Furthermore, mortality differs among ethnic groups. Our data provide insight in inter-ethnic differences in CAD risk factors, CAD severity and mortality.

No MeSH data available.


Related in: MedlinePlus