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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

Odds ratios of risk factors for the severity of CAD by ethnicity.Odds ratios derived from multivariable ordinal regression analysis, depicting the strength of association between cardiovascular risk factors and CAD severity (categorized into no CAD, single vessel disease, double vessel disease and triple vessel disease). The point estimates and 95% confidence intervals are shown for each ethnic group. A larger odds ratio indicates a stronger association between the risk factor and CAD severity. The asterisks (*) indicate significant interactions (p<0.05) of the risk factor as compared to Whites.
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pone.0132278.g002: Odds ratios of risk factors for the severity of CAD by ethnicity.Odds ratios derived from multivariable ordinal regression analysis, depicting the strength of association between cardiovascular risk factors and CAD severity (categorized into no CAD, single vessel disease, double vessel disease and triple vessel disease). The point estimates and 95% confidence intervals are shown for each ethnic group. A larger odds ratio indicates a stronger association between the risk factor and CAD severity. The asterisks (*) indicate significant interactions (p<0.05) of the risk factor as compared to Whites.

Mentions: The odds ratios (ORs) of specific cardiovascular risk factors for CAD severity differed between ethnic groups, as can be observed in Fig 2. The odds ratios in Fig 2 depict the ethnicity-specific odds for a given change in risk factor (for example diabetes yes or no or and increase in age of 10 years) to move up one CAD severity class (for example from single to double vessel disease, or from double to triple vessel disease).


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)

Odds ratios of risk factors for the severity of CAD by ethnicity.Odds ratios derived from multivariable ordinal regression analysis, depicting the strength of association between cardiovascular risk factors and CAD severity (categorized into no CAD, single vessel disease, double vessel disease and triple vessel disease). The point estimates and 95% confidence intervals are shown for each ethnic group. A larger odds ratio indicates a stronger association between the risk factor and CAD severity. The asterisks (*) indicate significant interactions (p<0.05) of the risk factor as compared to Whites.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0132278.g002: Odds ratios of risk factors for the severity of CAD by ethnicity.Odds ratios derived from multivariable ordinal regression analysis, depicting the strength of association between cardiovascular risk factors and CAD severity (categorized into no CAD, single vessel disease, double vessel disease and triple vessel disease). The point estimates and 95% confidence intervals are shown for each ethnic group. A larger odds ratio indicates a stronger association between the risk factor and CAD severity. The asterisks (*) indicate significant interactions (p<0.05) of the risk factor as compared to Whites.
Mentions: The odds ratios (ORs) of specific cardiovascular risk factors for CAD severity differed between ethnic groups, as can be observed in Fig 2. The odds ratios in Fig 2 depict the ethnicity-specific odds for a given change in risk factor (for example diabetes yes or no or and increase in age of 10 years) to move up one CAD severity class (for example from single to double vessel disease, or from double to triple vessel disease).

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