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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

The adjusted odds ratios of Chinese, Indian and Malay ethnicity for the severity of CAD in subgroups of the UNICORN cohort.The adjusted association (odds ratios plus confidence intervals) of Chinese, Indian and Malay ethnicity as compared to White ethnicity for CAD severity, depicted for the total cohort and subgroups of the UNICORN cohort. The displayed odds ratios are derived from a multivariable model containing: age, gender, diabetes, hypertension, dyslipidemia, smoking, BMI, prior acute coronary syndrome, indication for coronary angiogram and use of anti-platelet medication, statins, beta-blocker and RAAS medication.
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pone.0132278.g003: The adjusted odds ratios of Chinese, Indian and Malay ethnicity for the severity of CAD in subgroups of the UNICORN cohort.The adjusted association (odds ratios plus confidence intervals) of Chinese, Indian and Malay ethnicity as compared to White ethnicity for CAD severity, depicted for the total cohort and subgroups of the UNICORN cohort. The displayed odds ratios are derived from a multivariable model containing: age, gender, diabetes, hypertension, dyslipidemia, smoking, BMI, prior acute coronary syndrome, indication for coronary angiogram and use of anti-platelet medication, statins, beta-blocker and RAAS medication.

Mentions: From a multivariable ordinal logistic regression model containing ethnicity as a covariate, we obtained ORs for Chinese, Indian and Malay ethnicity as compared to White ethnicity for the angiographic severity of CAD in the total cohort, and in specific subgroups. The results are displayed in Fig 3. Within the total cohort, ORs for Chinese and Malay ethnicity were significantly higher (1.4 [1.1–1.7] and 1.9 [1.4–2.6], respectively) using Whites as the reference group. Indicating Chinese and Malay but not Indian ethnicity, were independently associated with more severe CAD within the total cohort. This finding was largely driven by a striking interaction between ethnicity and diabetes with respect to severity of CAD. Among diabetics all Asian ethnicities were independently associated with more severe CAD as compared to White ethnicity whereas in non-diabetics this independent association of ethnicity with the severity of CAD was not observed (Fig 3).


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)

The adjusted odds ratios of Chinese, Indian and Malay ethnicity for the severity of CAD in subgroups of the UNICORN cohort.The adjusted association (odds ratios plus confidence intervals) of Chinese, Indian and Malay ethnicity as compared to White ethnicity for CAD severity, depicted for the total cohort and subgroups of the UNICORN cohort. The displayed odds ratios are derived from a multivariable model containing: age, gender, diabetes, hypertension, dyslipidemia, smoking, BMI, prior acute coronary syndrome, indication for coronary angiogram and use of anti-platelet medication, statins, beta-blocker and RAAS medication.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0132278.g003: The adjusted odds ratios of Chinese, Indian and Malay ethnicity for the severity of CAD in subgroups of the UNICORN cohort.The adjusted association (odds ratios plus confidence intervals) of Chinese, Indian and Malay ethnicity as compared to White ethnicity for CAD severity, depicted for the total cohort and subgroups of the UNICORN cohort. The displayed odds ratios are derived from a multivariable model containing: age, gender, diabetes, hypertension, dyslipidemia, smoking, BMI, prior acute coronary syndrome, indication for coronary angiogram and use of anti-platelet medication, statins, beta-blocker and RAAS medication.
Mentions: From a multivariable ordinal logistic regression model containing ethnicity as a covariate, we obtained ORs for Chinese, Indian and Malay ethnicity as compared to White ethnicity for the angiographic severity of CAD in the total cohort, and in specific subgroups. The results are displayed in Fig 3. Within the total cohort, ORs for Chinese and Malay ethnicity were significantly higher (1.4 [1.1–1.7] and 1.9 [1.4–2.6], respectively) using Whites as the reference group. Indicating Chinese and Malay but not Indian ethnicity, were independently associated with more severe CAD within the total cohort. This finding was largely driven by a striking interaction between ethnicity and diabetes with respect to severity of CAD. Among diabetics all Asian ethnicities were independently associated with more severe CAD as compared to White ethnicity whereas in non-diabetics this independent association of ethnicity with the severity of CAD was not observed (Fig 3).

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