Distribution of coronary artery disease severity and risk factors in Afro-Caribbeans.
BACKGROUND
Traditional risk factors are strong predictors of the incidence of coronary artery disease (CAD), but their association with disease severity remains controversial and could differ across ethnic groups.


OBJECTIVE
In this study, we assessed the prevalence of cardiovascular risk factors (CRFs) in Afro-Caribbean patients with documented CAD, and sought to identify which of these factors are related to disease severity.


METHODS
We retrospectively studied 420 consecutive patients with CAD. Disease severity was determined from the results of invasive coronary angiography, based on the presence or absence of multiple (two or three) diseased vessels and the myocardial jeopardy (MJ) score.


RESULTS
In the studied population (mean age 64.7 ± 12.4 years), hypertension, diabetes and dyslipidaemia were the most frequent modifiable CRFs, present in 75.9, 47.8 and 37.8% of patients, respectively. Multiple logistic regression analysis showed that diabetes, male sex and personal cardiovascular history significantly increased the risk of multivessel CAD: odds ratios (ORs) of 1.53 (1.01-2.33; P=0.048), 1.61 (1.02-2.55; P=0.043) and 1.68 (1.11-2.56; P=0.015), respectively. Obesity was an independent negative predictor, with an OR of 0.48 (0.29-0.79; P=0.004). Other traditional CRFs (hypertension, dyslipidaemia, smoking, age and family history of vascular disease) were not associated with CAD severity. For high-risk lesions (MJ score ≥8), both diabetes and hypertension were independent predictors of disease severity, whereas obesity was no longer a protective factor.


CONCLUSIONS
Diabetes emerged as the strongest modifiable risk factor predictor of multivessel disease in Afro-Caribbean patients, whereas obesity was an independent protective factor. The underlying mechanisms of these associations should be relevant to disease prevention.
Cardiology Unit, University Hospital of Pointe-à-Pitre, 97159 Pointe-à-Pitre, Guadeloupe; Research Group, Clinical Epidemiology and Medicine, University of Antilles and Guyana, Pointe-à-Pitre, Guadeloupe. Electronic address: llarifla@orange.fr.
Laurent
L
Larifla
Research Group, Clinical Epidemiology and Medicine, University of Antilles and Guyana, Pointe-à-Pitre, Guadeloupe; Department of Public Health and Medical Information, University Hospital of Pointe-à-Pitre, Pointe-à-Pitre, Guadeloupe.
Christophe
C
Armand
Research Group, Clinical Epidemiology and Medicine, University of Antilles and Guyana, Pointe-à-Pitre, Guadeloupe.
Fritz-Line
FL
Velayoudom-Cephise
Cardiology Unit, University Hospital of Pointe-à-Pitre, 97159 Pointe-à-Pitre, Guadeloupe.
Guy
G
Weladji
Cardiology Unit, University Hospital of Pointe-à-Pitre, 97159 Pointe-à-Pitre, Guadeloupe.
Carl Thony
CT
Michel
Research Group, Clinical Epidemiology and Medicine, University of Antilles and Guyana, Pointe-à-Pitre, Guadeloupe.
Anne
A
Blanchet-Deverly
Research Group, Clinical Epidemiology and Medicine, University of Antilles and Guyana, Pointe-à-Pitre, Guadeloupe.
Jacqueline
J
Deloumeaux
Research Group, Clinical Epidemiology and Medicine, University of Antilles and Guyana, Pointe-à-Pitre, Guadeloupe; Department of Public Health and Medical Information, University Hospital of Pointe-à-Pitre, Pointe-à-Pitre, Guadeloupe.
Lydia
L
Foucan
D000368:Aged; D044383:Black People; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000208:ethnology*; D003920:Diabetes Mellitus / Q000208:ethnology; D019430:Guadeloupe / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000208:ethnology; D016017:Odds Ratio; D015995:Prevalence; D065840:Protective Factors; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
Afro-Caribbean; Afro-caribéen; Coronarographie; Coronaropathie; Coronary angiography; Coronary artery disease; Facteurs de risque; Risk factors