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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

Adjusted survival probability from multivariable Cox regression analysis by ethnicity.Survival probability derived from multivariable Cox regression analysis. Ethnicity-specific curves are adjusted for: age, gender, indication for angiography, conclusion from angiography, diabetes, dyslipidemia, previous ACS, statin use, platelet inhibitor use, beta blocker use and RAAS-inhibiting medication use. White, Chinese and Indian ethnicity were significantly associated with a better survival as compared to Malay ethnicity (Whites: HR 0.4 [0.2–0.8], p = 0.009, Chinese: HR 0.5 [0.3–0.98], p = 0.044, Indians HR 0.4 [0.1–0.98], p = 0.046).
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pone.0132278.g004: Adjusted survival probability from multivariable Cox regression analysis by ethnicity.Survival probability derived from multivariable Cox regression analysis. Ethnicity-specific curves are adjusted for: age, gender, indication for angiography, conclusion from angiography, diabetes, dyslipidemia, previous ACS, statin use, platelet inhibitor use, beta blocker use and RAAS-inhibiting medication use. White, Chinese and Indian ethnicity were significantly associated with a better survival as compared to Malay ethnicity (Whites: HR 0.4 [0.2–0.8], p = 0.009, Chinese: HR 0.5 [0.3–0.98], p = 0.044, Indians HR 0.4 [0.1–0.98], p = 0.046).

Mentions: Crude all-cause mortality rates (from Kaplan Meier analysis) showed lowest survival probability among Whites, and highest in Indians (Table 1, log-rank test for difference across the ethnic groups p = 0.17). On correction for covariates by Cox regression analysis to assess the independent effect of ethnicity on all-cause mortality, survival in Malays fell below that in Chinese, Indians and Whites (Fig 4). White, Chinese and Indian ethnicity were significantly associated with a better survival as compared to Malay ethnicity (Whites: HR 0.4 [0.2–0.8], p = 0.009, Chinese: HR 0.5 [0.3–0.98], p = 0.044, Indians HR 0.4 [0.1–0.98], p = 0.046).


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)

Adjusted survival probability from multivariable Cox regression analysis by ethnicity.Survival probability derived from multivariable Cox regression analysis. Ethnicity-specific curves are adjusted for: age, gender, indication for angiography, conclusion from angiography, diabetes, dyslipidemia, previous ACS, statin use, platelet inhibitor use, beta blocker use and RAAS-inhibiting medication use. White, Chinese and Indian ethnicity were significantly associated with a better survival as compared to Malay ethnicity (Whites: HR 0.4 [0.2–0.8], p = 0.009, Chinese: HR 0.5 [0.3–0.98], p = 0.044, Indians HR 0.4 [0.1–0.98], p = 0.046).
© Copyright Policy
Related In: Results  -  Collection

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

pone.0132278.g004: Adjusted survival probability from multivariable Cox regression analysis by ethnicity.Survival probability derived from multivariable Cox regression analysis. Ethnicity-specific curves are adjusted for: age, gender, indication for angiography, conclusion from angiography, diabetes, dyslipidemia, previous ACS, statin use, platelet inhibitor use, beta blocker use and RAAS-inhibiting medication use. White, Chinese and Indian ethnicity were significantly associated with a better survival as compared to Malay ethnicity (Whites: HR 0.4 [0.2–0.8], p = 0.009, Chinese: HR 0.5 [0.3–0.98], p = 0.044, Indians HR 0.4 [0.1–0.98], p = 0.046).
Mentions: Crude all-cause mortality rates (from Kaplan Meier analysis) showed lowest survival probability among Whites, and highest in Indians (Table 1, log-rank test for difference across the ethnic groups p = 0.17). On correction for covariates by Cox regression analysis to assess the independent effect of ethnicity on all-cause mortality, survival in Malays fell below that in Chinese, Indians and Whites (Fig 4). White, Chinese and Indian ethnicity were significantly associated with a better survival as compared to Malay ethnicity (Whites: HR 0.4 [0.2–0.8], p = 0.009, Chinese: HR 0.5 [0.3–0.98], p = 0.044, Indians HR 0.4 [0.1–0.98], p = 0.046).

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