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![Page 1: Ethnic differences in risks and explanations for the cardiometabolic syndrome in the UK Nish Chaturvedi Professor of Clinical Epidemiology Imperial College.](https://reader035.fdocuments.us/reader035/viewer/2022062515/56649c945503460f9495081b/html5/thumbnails/1.jpg)
Ethnic differences in risks and explanations for the cardiometabolic syndrome in the UK
Nish Chaturvedi
Professor of Clinical Epidemiology
Imperial College NHS HealthCare Trust
![Page 2: Ethnic differences in risks and explanations for the cardiometabolic syndrome in the UK Nish Chaturvedi Professor of Clinical Epidemiology Imperial College.](https://reader035.fdocuments.us/reader035/viewer/2022062515/56649c945503460f9495081b/html5/thumbnails/2.jpg)
• Highlights of what we found from the Southall and
Brent studies performed 20 years ago
• Rationale for follow up of this cohort (SABRE)
• How we hope you can help us
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Ethnic differences in SMRs for heart disease and stroke in the UK –
age 20-69 for 1989-92 – general population
IHDStroke
02040
6080
100
120
140
160
European
South Asian
African Caribbean
Men
IHD Stroke0
20
40
60
80
100
120
140
160
Women
Wild S, BMJ 97
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CHD risk factors in South Asian men by subgroup, compared with native British men
Native Sikh Punjabi Gujarati Muslim p†
British Hindu Hindu
Current smokers (%) 30 4 21 33 30<0.001
Cholesterol 6.12 6.06 5.94 5.45 5.95<0.001
Median BP (mmHg) 121 128 126 122 120
<0.001
Diabetes prevalence (%) 5 20 19 22 19 NS
2 h insulin (mU/l)‡ 19 39 42 49 43 NS
WHR 0.93 0.97 0.98 0.97 0.97 NS
Fasting TG 1.48 1.73 1.74 1.49 1.85 0.02
†For differences among South Asian subgroups
McKeigue, PM;Lancet:1991
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Insulin resistance
(hyperinsulinaemia)
Associated with central obesity
Glucose intolerance
Dyslipidaemia TG HDLHypertension
Coagulation abnormalities
Diabetes
CHD
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CHD mortality in South Asian versus European men – Brent & Southall study
(1988-2003)*
ADJUSTED FOR HR 95% CI P
Age 1.62 1.24, 2.11 <0.001
Age & diabetes 1.33 1.01 1.76 0.04
Age, smoking, cholesterol, metabolic syndrome 2.11 1.56 2.84 <0.001
*113+ in South Asian118+ in Europeans
Adapted from Forouhi N, Diabetologia 2006
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Risk of CHD Mortality associated with diabetes in Europeans and South Asians
Adapted from: Forouhi et al 2006
0
1
2
3
4
Europeans South Asians
Hazard
rati
o f
or
dia
bete
s
Multivariate models adjusted for age, triglycerides, waist circumference, insulin, cholesterol, blood pressure and smoking
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Cardiovascular risk factors in Afro-Caribbean and European men in the UK
Factor European African-Caribbean
BMI (kg/m2) 26.4 26
Diabetes (%) 6.5 12.9*
Smokers (%) 37 30
Alcohol (u/wk) 30 19
Exercise (mj/wk) 5.3 4.9
Insulin (MU/L) 6.6 8.3*
Cholesterol (mmol/L) 5.9 5.4*
Manual SES (%) 62 81*
Chaturvedi N Diabetologia 1994
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Age adjusted means of lipids and lipoproteins by ethnic group in men
European African-Caribbean p
Cholesterol (mmol/l) 5.85 5.35 0.0001
Fasting triglyceride (mmol/l) 1.59 1.17 0.0001
HDL cholesterol (mmol/l) 1.33 1.49 0.001
Chaturvedi N Diabetologia 1994
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Insulin resistance
(hyperinsulinaemia)
Associated with central obesity
Glucose intolerance
Dyslipidaemia TG HDLHypertension
Coagulation abnormalities
Diabetes
CHD
![Page 11: Ethnic differences in risks and explanations for the cardiometabolic syndrome in the UK Nish Chaturvedi Professor of Clinical Epidemiology Imperial College.](https://reader035.fdocuments.us/reader035/viewer/2022062515/56649c945503460f9495081b/html5/thumbnails/11.jpg)
CHD mortality in African Caribbean versus European men – Brent & Southall study
(1988-2003)*
ADJUSTED FOR HR 95% CI P
Age 0.33 0.15 0.71 0.005
Age & smoking 0.36 0.17 0.78 0.01
Age & MS (IDF) 0.29 0.11 0.42 <0.001
Age, HOMA IR, TG, waist 0.35 0.15 0.80 0.013
Age, smoking, cholesterol, BP 0.33 0.15 0.71 0.005
*7+ in African Caribbeans118+ in Europeans Tillin T – Diabetes Care, 2007
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Hypertension prevalence and mean blood pressure in African Caribbeans and
Europeans (40-64)European African Caribbean
Men
Hypertension (%) 14 32
Systolic BP (mmHg) 122 128
Women
Hypertension (%) 13 37
Systolic BP (mmHg) 118 135
Chaturvedi et al, Hypertension;1993
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Mean 2 hour systolic ambulatory BP
100
110
120
130
140
150
0 4 8 12 16 20Time (hours)
Sys
toli
c B
P (
mm
ol/
l)European
Afro-Caribbean
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Stroke Mortality and ethnicity (age and sex adjusted) after 17.8 years f-up
Brent and Southall Studies 1989-91
0
1
2
3
Europeans SouthAsians
Africancaribbeans
Ha
za
rd r
ati
o
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• Is diabetes really more ‘toxic’ in South Asians and
African Caribbeans – and if so, why?
• What are the risks of heart failure and its
antecedents in ethnic minority groups?
• Should we be treating CVD risk factors at different
thresholds in ethnic minorities?
Outstanding questions on ethnic differences in
metabolic syndrome and CVD (3)
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• 20 year follow-up, participants now aged 55-85,
mean age 67
• Continue mortality flagging (ONS)
• Morbidity FU. CVD, diabetes and hypertension
events/diagnoses since baseline by a) participant
questionnaire, b) GP record review
• Clinical examination in survivors
Southall And Brent REvisited – SABRE
2008-2011
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• Questionnaire, demographic, lifestyle, medical history
• Height, weight, waist, bioimpedence (% body fat)
• Resting and ambulatory BP
• Coronary calcification on CT – coronary atherosclerosis
• Cerebral MRI for infarcts
• Echocardiography, carotid IMT
• Fasting bloods, glucose tolerance, lipids
• Retinal photographs – retinopathy, AMD – maybe cataract
• Cognitive function
Southall And Brent REvisited – SABREClinical follow up
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SABRE study participants ‘status’ in March 2011
Status European South Asian African Caribbean
Total
Deceased 589 (25%) 356 (21%) 120 (15%) 1065 (22%)
MR review in deceased
423 (71%) 296 (82%) 99 (82%) 818 (76%)
Survivors 1758 1356 680 3794
Attended clinic 685 (39%) 522 (39%) 231 (34%) 1438 (38%)
Nurse home visit 9 (0.5%) 14 (1%) 6 (1%) 29 (0.8%)
MR review&/or questionnaire only
341 (19%) 238 ( 18%) 83 (12%) 662 (17%)
ANY participation 1035 (59%) 775 (57%) 320 (47%) 2130 (56%)
Refused 385 (22%) 381 (28%) 163 (24%) 929 (24%)
Untraced 118 (7%) 58 (4%) 103 (15%) 279 (7%)
No response 187 (11%) 103 (8%) 55 (8%) 345 (9%)
Away/unwell 33 (2%) 39 (3%) 39 (6%) 111 (3%)
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Pre-diabetes and diagnosed/undiagnosed diabetes (2010)
Unpublished data from 1290 people, age 59-86, ongoing follow-up of the Southall and Brent population-based cohort,
(SABRE study, 2010)