Ethnic differences in cardiovascular risk: examining differential exposure and susceptibility to risk factors

Ho, F., Gray, S. R. , Welsh, P. , Gill, J. M.R. , Sattar, N. , Pell, J. P. and Celis-Morales, C. (2022) Ethnic differences in cardiovascular risk: examining differential exposure and susceptibility to risk factors. BMC Medicine, 20(1), 149. (doi: 10.1186/s12916-022-02337-w) (PMID:35473626) (PMCID:PMC9042646)

Abstract

Background: Ethnic differences in cardiovascular disease (CVD) risk have been known for decades, but a systematic exploration of how exposure and susceptibility to risk factors may contribute is lacking. This study aimed to investigate the potential impact of differential exposure and susceptibility between South Asian, Black, and White individuals. Methods: This is a population-based prospective cohort study of UK Biobank participants with a median follow-up of 11.3 years. The association between ethnic group and CVD risk was studied. Additional risk factors were then adjusted to examine mediations. Moderation analysis was conducted to identify whether risk factors had a stronger association in the ethnic minority groups. Population attributable fractions were also calculated to quantify the relative contributions of risk factors for each ethnic group. Results: When adjusted for only age and sex, there was a higher risk of CVD among South Asian (n=8815; HR [95% CI] 1.69 [1.59–1.79]) and Black (n=7526; HR [95% CI] 1.12 [1.03–1.22]) compared with White participants (n=434,809). The excess risk of Black participants was completely attenuated following adjustment for deprivation. Compared with White participants, the associations of BMI, triglycerides, and HbA1c with CVD were stronger in South Asians. Adiposity was attributable to the highest proportion of CVD regardless of ethnicity. Smoking had the second largest contribution to CVD among White and Black participants, and HbA1c among South Asian participants. Conclusions: Adiposity is an important risk factor for CVD regardless of ethnicity. Ethnic inequalities in CVD incidence may be best tackled by targeting interventions according to ethnic differences in risk profiles.

• Item Type: Articles
• Additional Information: This study was supported by the University of Glasgow reinvigorating research fund. UK Biobank was established by the Wellcome Trust Medical Research Council, Department of Health, Scottish government, and Northwest Regional Development Agency. It has also had funding from the Welsh assembly government and the British Heart Foundation.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Celis, Dr Carlos and Pell, Professor Jill and Gray, Professor Stuart and Gill, Professor Jason and Ho, Dr Frederick and Sattar, Professor Naveed and Welsh, Professor Paul
• Authors: Ho, F., Gray, S. R., Welsh, P., Gill, J. M.R., Sattar, N., Pell, J. P., and Celis-Morales, C.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
• Journal Name: BMC Medicine
• Publisher: BioMed Central
• ISSN: 1741-7015
• ISSN (Online): 1741-7015
• Copyright Holders: Copyright © 2022 The Authors
• First Published: First published in BMC Medicine 20(1):149
• Publisher Policy: Reproduced under a Creative Commons License