Ethnic differences in risks and explanations for the cardiometabolic syndrome in the UK Nish Chaturvedi Professor of Clinical Epidemiology Imperial College.

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Presentation transcript:

Ethnic differences in risks and explanations for the cardiometabolic syndrome in the UK Nish Chaturvedi Professor of Clinical Epidemiology Imperial College NHS HealthCare Trust

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

Ethnic differences in SMRs for heart disease and stroke in the UK – age for – general population Wild S, BMJ 97

CHD risk factors in South Asian men by subgroup, compared with native British men NativeSikhPunjabiGujaratiMuslimp † BritishHindu Hindu Current smokers (%) <0.001 Cholesterol <0.001 Median BP (mmHg) <0.001 Diabetes prevalence (%) NS 2 h insulin (mU/l) ‡ NS WHR NS Fasting TG † For differences among South Asian subgroups McKeigue, PM;Lancet:1991

Insulin resistance (hyperinsulinaemia) Associated with central obesity Glucose intolerance Dyslipidaemia TG  HDL  Hypertension Coagulation abnormalities Diabetes CHD

CHD mortality in South Asian versus European men – Brent & Southall study ( )* ADJUSTED FORHR95%CIP Age ,2.11<0.001 Age & diabetes Age, smoking, cholesterol, metabolic syndrome <0.001 *113+ in South Asian 118+ in Europeans Adapted from Forouhi N, Diabetologia 2006

Risk of CHD Mortality associated with diabetes in Europeans and South Asians Adapted from: Forouhi et al 2006 Multivariate models adjusted for age, triglycerides, waist circumference, insulin, cholesterol, blood pressure and smoking

Cardiovascular risk factors in Afro- Caribbean and European men in the UK FactorEuropeanAfrican-Caribbean BMI (kg/m 2 ) Diabetes (%) * Smokers (%)3730 Alcohol (u/wk)3019 Exercise (mj/wk) Insulin (MU/L)6.68.3* Cholesterol (mmol/L)5.95.4* Manual SES (%)6281* Chaturvedi N Diabetologia 1994

Age adjusted means of lipids and lipoproteins by ethnic group in men EuropeanAfrican-Caribbeanp Cholesterol (mmol/l) Fasting triglyceride (mmol/l) HDL cholesterol (mmol/l) Chaturvedi N Diabetologia 1994

Insulin resistance (hyperinsulinaemia) Associated with central obesity Glucose intolerance Dyslipidaemia TG  HDL  Hypertension Coagulation abnormalities Diabetes CHD

CHD mortality in African Caribbean versus European men – Brent & Southall study ( )* ADJUSTED FORHR95%CIP Age Age & smoking Age & MS (IDF) <0.001 Age, HOMA IR, TG, waist Age, smoking, cholesterol, BP *7+ in African Caribbeans 118+ in Europeans Tillin T – Diabetes Care, 2007

Hypertension prevalence and mean blood pressure in African Caribbeans and Europeans (40-64) EuropeanAfrican Caribbean Men Hypertension (%)1432 Systolic BP (mmHg) Women Hypertension (%) 1337 Systolic BP (mmHg) Chaturvedi et al, Hypertension;1993

Mean 2 hour systolic ambulatory BP

Stroke Mortality and ethnicity (age and sex adjusted) after 17.8 years f-up Brent and Southall Studies

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)

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

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 – SABRE Clinical follow up

SABRE study participants ‘status’ in March 2011 StatusEuropeanSouth AsianAfrican Caribbean Total Deceased589 (25%)356 (21%)120 (15%)1065 (22%) MR review in deceased 423 (71%)296 (82%)99 (82%)818 (76%) Survivors Attended clinic685 (39%)522 (39%)231 (34%)1438 (38%) Nurse home visit9 (0.5%)14 (1%)6 (1%)29 (0.8%) MR review&/or questionnaire only 341 (19%)238 ( 18%)83 (12%)662 (17%) ANY participation1035 (59%)775 (57%)320 (47%)2130 (56%) Refused385 (22%)381 (28%)163 (24%)929 (24%) Untraced118 (7%)58 (4%)103 (15%)279 (7%) No response187 (11%)103 (8%)55 (8%)345 (9%) Away/unwell33 (2%)39 (3%)39 (6%)111 (3%)

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)