1. An assessment of correlation between ethnicity and modifiable risk factors in the context of primary prevention of cardiovascular disease Patel PA2, Ali N1, Watson V1, Bulugahapitiya S1 1Department of Cardiology, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ 2Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, United Kingdom
Purpose
Results
Caucasian patients
(n=535)
Asian patients (n=424)
P value
Current smoker [%]
194 [36]
123 [29]
0.02*
Elevated BMI [%]
181 [34]
154 [36]
0.65
Mean systolic BP (mmHg)
145
148
0.08
Mean diastolic BP (mmHg) 71 72
0.12
Mean QRISK2 score (%)
18.1
20.1
0.61
Appropriate statin therapy [%]
460 [86]
314 [74]
0.01*
Rate of statin discontinuation (%) 9 14
0.05
Cardiovascular disease (CVD) secondary to atherosclerosis accounts for 33% of all-cause mortality in the UK.
Ethnic background is an established risk factor, with higher preponderance in South Asians due to a combination of genetic and environmental influences.
Bradford has the highest density of South Asians per capita in the UK (20%), predominantly originating from Pakistan.
This prospective study sought to assess correlations between ethnic background and modifiable risk factors associated with CVD.
Moreover, we wished to establish the proportion of patients who are appropriately prescribed statins for primary prevention of CVD, thereby quantifying compliance with UK NICE guidelines (CG181).
959 patients were suitable for inclusion (56% Caucasian [535/959] vs. 44% Asian [424/959]).
When comparing Caucasian to Asian patients, no significant differences were seen with respect to mean systolic blood pressure (145 vs 148; p=0.08), mean diastolic blood pressure (71 vs 72; p=0.12), proportion of patients with an elevated BMI (34% [181/535] vs. 36% [154/424]; p=0.64), or mean QRISK2 score (18.1% vs. 20.1%; p=0.61).
In contrast, when comparing Caucasian to Asian patients, significant differences were noted in the proportion of those who are current smokers (36% [194/535] vs. 29% [123/424]; p=0.02) and the proportion of those with a QRISK2 score >10% on appropriate statin therapy , as advocated by UK NICE guidelines (14% (75/535) vs. 26% (110/424); p=0.01).
It was also noted that Asian patients had a higher discontinuation rate of statin therapy than Caucasian counterparts (14% vs. 9%; p=0.05)
Table 1. A comparison between Caucasian and Asian patients who present to the
Emergency Department with chest pain (*-statistical significance; BMI – body mass index).
Methods
Conclusions
All patients who attended the emergency department (ED) of a busy teaching hospital within the UK with a complaint of ‘chest pain’ were assessed.
Attendances between August and October 2016 inclusive were included. Any patients with a subsequent positive troponin result suggestive of myocardial infarction were excluded.
South Asians were defined as those whose ancestry originated from the Indian subcontinent.
For each patient, presence of modifiable risk factors was documented and calculation of QRISK2 score made as a prediction algorithm for CVD.
Statistical analysis was performed using chi-squared testing for categorical variables and Mann-Whitney U test for non-parametric, discrete data. Statistical significance was defined by p-values <0.05.
P=0.01
This single-centre study provides a real-world perspective of variations between Caucasian and South Asian subpopulations, and profiles for traditional risk factors were broadly comparable.
Interestingly, whilst the mean QRISK2 scores suggest that patients presenting with ‘chest pain’ are at high risk of future CVD, compliance with national guidelines for initiation of statin therapy is suboptimal.
This disparity appears most marked amongst Asian patients, with cultural and language barriers potentially implicated.
Based on findings, we advocate the need for better awareness of primary prevention guidelines amongst clinicians in addition to larger, multi-centre trials to explore trends further.
Figure 1. A comparison between the proportion of Caucasian and Asian patients with a QRISK2 score >10% who are on appropriate statin therapy.
Declaration of interests - None