title: The relationship between metabolic risk factors and incident cardiovascular disease in Europeans, South Asians, and African Caribbeans: SABRE (Southall and Brent Revisited) -- a prospective population-based study.
abstract: OBJECTIVE
  This study sought to determine whether ethnic differences in diabetes, dyslipidemia, and ectopic fat deposition account for ethnic differences in incident cardiovascular disease.
  
  
  BACKGROUND
  Coronary heart disease risks are elevated in South Asians and are lower in African Caribbeans compared with Europeans. These ethnic differences map to lipid patterns and ectopic fat deposition.
  
  
  METHODS
  Cardiovascular risk factors were assessed in 2,049 Europeans, 1,517 South Asians, and 630 African Caribbeans from 1988 through 1991 (mean age: 52.4 ± 6.9 years). Fatal and nonfatal events were captured over a median 20.5-year follow-up. Subhazard ratios (SHR) were calculated using competing risks regression.
  
  
  RESULTS
  Baseline diabetes prevalence was more than 3 times greater in South Asians and African Caribbeans than in Europeans. South Asians were more and African Caribbeans were less centrally obese and dyslipidemic than Europeans. Compared with Europeans, coronary heart disease incidence was greater in South Asians and less in African Caribbeans. The age- and sex-adjusted South Asian versus European SHR was 1.70 (95% confidence interval [CI]: 1.52 to 1.91, p < 0.001) and remained significant (1.45, 95% CI: 1.28 to 1.64, p < 0.001) when adjusted for waist-to-hip ratio. The African Caribbean versus European age- and sex-adjusted SHR of 0.64 (95% CI: 0.52 to 0.79, p < 0.001) remained significant when adjusted for high-density lipoprotein and low-density lipoprotein cholesterol (0.74, 95% CI: 0.60 to 0.92, p = 0.008). Compared with Europeans, South Asians and African Caribbeans experienced more strokes (age- and sex-adjusted SHR: 1.45 [95% CI: 1.17 to 1.80, p = 0.001] and 1.50 [95% CI: 1.13 to 2.00, p = 0.005], respectively), and this differential was more marked in those with diabetes (age-adjusted SHR: 1.97 [95% CI: 1.16 to 3.35, p = 0.038 for interaction] and 2.21 [95% CI: 1.14 to 4.30, p = 0.019 for interaction]).
  
  
  CONCLUSIONS
  Ethnic differences in measured metabolic risk factors did not explain differences in coronary heart disease incidence. The apparently greater association between diabetes and stroke risk in South Asians and African Caribbeans compared with Europeans merits further study.
authors.affiliation: International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom. t.tillin@imperial.ac.uk
authors.forename: Therese
authors.initials: T
authors.lastname: Tillin
authors.forename: Alun D
authors.initials: AD
authors.lastname: Hughes
authors.forename: Jamil
authors.initials: J
authors.lastname: Mayet
authors.forename: Peter
authors.initials: P
authors.lastname: Whincup
authors.forename: Naveed
authors.initials: N
authors.lastname: Sattar
authors.forename: Nita G
authors.initials: NG
authors.lastname: Forouhi
authors.forename: Paul M
authors.initials: PM
authors.lastname: McKeigue
authors.forename: Nish
authors.initials: N
authors.lastname: Chaturvedi
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000208:ethnology; D000273:Adipose Tissue / Q000473:pathology; D000328:Adult; D000367:Age Factors; D000368:Aged; D001210:Asia, Southeastern; D044466:Asian People / Q000706:statistics & numerical data*; D044383:Black People / Q000706:statistics & numerical data*; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000097:blood* / Q000453:epidemiology* / Q000208:ethnology / Q000401:mortality; D017691:Caribbean Region / Q000208:ethnology; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003324:Coronary Artery Disease / Q000097:blood / Q000208:ethnology; D048909:Diabetes Complications / Q000097:blood / Q000208:ethnology; D050171:Dyslipidemias / Q000097:blood / Q000150:complications / Q000208:ethnology; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D015994:Incidence; D007328:Insulin / Q000097:blood; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000208:ethnology; D016017:Odds Ratio; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects; D020521:Stroke / Q000097:blood* / Q000453:epidemiology* / Q000208:ethnology; D011795:Surveys and Questionnaires; D014280:Triglycerides / Q000097:blood; D006113:United Kingdom / Q000453:epidemiology; D049629:Waist-Hip Ratio; D044465:White People / Q000706:statistics & numerical data*
chemical_list: D001786:Blood Glucose; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; D007328:Insulin; D014280:Triglycerides; C517652:hemoglobin A1c protein, human