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Race/Ethnic Differences in the Associations of the Framingham Risk Factors with Carotid IMT and Cardiovascular Events

Gijsberts CM 1 , Groenewegen KA 2 , Hoefer IE 1 , Eijkemans MJ 2 , Asselbergs FW 3 , Anderson TJ 4 Show all authors , Britton AR 5 , Dekker JM 6 , Engström G 7 , Evans GW 8 , de Graaf J 9 , Grobbee DE 10 , Hedblad B 7 , Holewijn S 9 , Ikeda A 11 , Kitagawa K 12 , Kitamura A 11 , de Kleijn DP 13 , Lonn EM 14 , Lorenz MW 15 , Mathiesen EB 16 , Nijpels G 6 , Okazaki S 17 , O'Leary DH 18 , Pasterkamp G 19 , Peters SA 2 , Polak JF 18 , Price JF 20 , Robertson C 20 , Rembold CM 21 , Rosvall M 7 , Rundek T 22 , Salonen JT 23 , Sitzer M 24 , Stehouwer CD 25 , Bots ML 2 , den Ruijter HM 26

Affiliations 

  • 1 Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
  • 2 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
  • 3 Department of Cardiology, Division Heart and Lungs, University Medical Centre Utrecht, Utrecht, The Netherlands; Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht, The Netherlands; Institute of Cardiovascular Science, faculty of Population Health Sciences, University College London, London, United Kingdom
  • 4 Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada
  • 5 Department of Epidemiology and Public Health University College London, London, United Kingdom
  • 6 Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
  • 7 Dept of Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Malmö, Sweden
  • 8 Department of Biostatistical Sciences and Neurology, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
  • 9 Department of General Internal Medicine, Division of Vascular Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
  • 10 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; University of Malaya Medical Center, Kuala Lumpur, Malaysia
  • 11 Osaka Medical Center for Health Science and Promotion, Osaka, Japan
  • 12 Department of Neurology, Tokyo Women Medical University, Tokyo, Japan
  • 13 Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands; Cardiovascular Research Institute & Surgery, Singapore, Singapore; Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
  • 14 Department of Medicine, Division of Cardiology and Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
  • 15 Department of Neurology, University Hospital, Goethe-University, Frankfurt am Main, Germany
  • 16 Brain and Circulation Research Group, Department of Clinical Medicine, University of Tromsø, Tromsø, Norway
  • 17 Stroke Center, Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan
  • 18 Department of Radiology, Tufts Medical Center, Boston, MA, United States of America
  • 19 Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
  • 20 Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
  • 21 Cardiology Division, Department of Internal Medicine, University of Virginia, Charlottesville, VA, United States of America
  • 22 Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, United States of America
  • 23 MAS-Metabolic Analytical Services Oy, Helsinki, Finland
  • 24 Department of Neurology, University Hospital, Goethe-University, Frankfurt am Main, Germany and Department of Neurology Klinikum Herford, Germany
  • 25 Department of Internal Medicine and Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
  • 26 Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
PLoS One, 2015;10(7):e0132321.
PMID: 26134404 DOI: 10.1371/journal.pone.0132321

Abstract

BACKGROUND: Clinical manifestations and outcomes of atherosclerotic disease differ between ethnic groups. In addition, the prevalence of risk factors is substantially different. Primary prevention programs are based on data derived from almost exclusively White people. We investigated how race/ethnic differences modify the associations of established risk factors with atherosclerosis and cardiovascular events.

METHODS: We used data from an ongoing individual participant meta-analysis involving 17 population-based cohorts worldwide. We selected 60,211 participants without cardiovascular disease at baseline with available data on ethnicity (White, Black, Asian or Hispanic). We generated a multivariable linear regression model containing risk factors and ethnicity predicting mean common carotid intima-media thickness (CIMT) and a multivariable Cox regression model predicting myocardial infarction or stroke. For each risk factor we assessed how the association with the preclinical and clinical measures of cardiovascular atherosclerotic disease was affected by ethnicity.

RESULTS: Ethnicity appeared to significantly modify the associations between risk factors and CIMT and cardiovascular events. The association between age and CIMT was weaker in Blacks and Hispanics. Systolic blood pressure associated more strongly with CIMT in Asians. HDL cholesterol and smoking associated less with CIMT in Blacks. Furthermore, the association of age and total cholesterol levels with the occurrence of cardiovascular events differed between Blacks and Whites.

CONCLUSION: The magnitude of associations between risk factors and the presence of atherosclerotic disease differs between race/ethnic groups. These subtle, yet significant differences provide insight in the etiology of cardiovascular disease among race/ethnic groups. These insights aid the race/ethnic-specific implementation of primary prevention.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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