title: Race/Ethnic Differences in the Associations of the Framingham Risk Factors with Carotid IMT and Cardiovascular Events.
abstract: BACKGROUND
  Clinical manifestations and outcomes of atherosclerotic disease differ between ethnic groups. In addition, the prevalence of risk factors is substantially different. Primary prevention programs are based on data derived from almost exclusively White people. We investigated how race/ethnic differences modify the associations of established risk factors with atherosclerosis and cardiovascular events.
  
  
  METHODS
  We used data from an ongoing individual participant meta-analysis involving 17 population-based cohorts worldwide. We selected 60,211 participants without cardiovascular disease at baseline with available data on ethnicity (White, Black, Asian or Hispanic). We generated a multivariable linear regression model containing risk factors and ethnicity predicting mean common carotid intima-media thickness (CIMT) and a multivariable Cox regression model predicting myocardial infarction or stroke. For each risk factor we assessed how the association with the preclinical and clinical measures of cardiovascular atherosclerotic disease was affected by ethnicity.
  
  
  RESULTS
  Ethnicity appeared to significantly modify the associations between risk factors and CIMT and cardiovascular events. The association between age and CIMT was weaker in Blacks and Hispanics. Systolic blood pressure associated more strongly with CIMT in Asians. HDL cholesterol and smoking associated less with CIMT in Blacks. Furthermore, the association of age and total cholesterol levels with the occurrence of cardiovascular events differed between Blacks and Whites.
  
  
  CONCLUSIONS
  The magnitude of associations between risk factors and the presence of atherosclerotic disease differs between race/ethnic groups. These subtle, yet significant differences provide insight in the etiology of cardiovascular disease among race/ethnic groups. These insights aid the race/ethnic-specific implementation of primary prevention.
authors.affiliation: Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands.
authors.forename: Crystel M
authors.initials: CM
authors.lastname: Gijsberts
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Karlijn A
authors.initials: KA
authors.lastname: Groenewegen
authors.affiliation: Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands.
authors.forename: Imo E
authors.initials: IE
authors.lastname: Hoefer
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Marinus J C
authors.initials: MJ
authors.lastname: Eijkemans
authors.affiliation: Department of Cardiology, Division Heart and Lungs, University Medical Centre Utrecht, Utrecht, The Netherlands; Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht, The Netherlands; Institute of Cardiovascular Science, faculty of Population Health Sciences, University College London, London, United Kingdom.
authors.forename: Folkert W
authors.initials: FW
authors.lastname: Asselbergs
authors.affiliation: Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada.
authors.forename: Todd J
authors.initials: TJ
authors.lastname: Anderson
authors.affiliation: Department of Epidemiology and Public Health University College London, London, United Kingdom.
authors.forename: Annie R
authors.initials: AR
authors.lastname: Britton
authors.affiliation: Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Jacqueline M
authors.initials: JM
authors.lastname: Dekker
authors.affiliation: Dept of Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Malmö, Sweden.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Engström
authors.affiliation: Department of Biostatistical Sciences and Neurology, Wake Forest School of Medicine, Winston-Salem, NC, United States of America.
authors.forename: Greg W
authors.initials: GW
authors.lastname: Evans
authors.affiliation: Department of General Internal Medicine, Division of Vascular Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: de Graaf
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; University of Malaya Medical Center, Kuala Lumpur, Malaysia.
authors.forename: Diederick E
authors.initials: DE
authors.lastname: Grobbee
authors.affiliation: Dept of Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Malmö, Sweden.
authors.forename: Bo
authors.initials: B
authors.lastname: Hedblad
authors.affiliation: Department of General Internal Medicine, Division of Vascular Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Holewijn
authors.affiliation: Osaka Medical Center for Health Science and Promotion, Osaka, Japan.
authors.forename: Ai
authors.initials: A
authors.lastname: Ikeda
authors.affiliation: Department of Neurology, Tokyo Women Medical University, Tokyo, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kitagawa
authors.affiliation: Osaka Medical Center for Health Science and Promotion, Osaka, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Kitamura
authors.affiliation: Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands; Cardiovascular Research Institute & Surgery, Singapore, Singapore; Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Dominique P V
authors.initials: DP
authors.lastname: de Kleijn
authors.affiliation: Department of Medicine, Division of Cardiology and Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Eva M
authors.initials: EM
authors.lastname: Lonn
authors.affiliation: Department of Neurology, University Hospital, Goethe-University, Frankfurt am Main, Germany.
authors.forename: Matthias W
authors.initials: MW
authors.lastname: Lorenz
authors.affiliation: Brain and Circulation Research Group, Department of Clinical Medicine, University of Tromsø, Tromsø, Norway.
authors.forename: Ellisiv B
authors.initials: EB
authors.lastname: Mathiesen
authors.affiliation: Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Giel
authors.initials: G
authors.lastname: Nijpels
authors.affiliation: Stroke Center, Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Shuhei
authors.initials: S
authors.lastname: Okazaki
authors.affiliation: Department of Radiology, Tufts Medical Center, Boston, MA, United States of America.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: O'Leary
authors.affiliation: Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Gerard
authors.initials: G
authors.lastname: Pasterkamp
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Sanne A E
authors.initials: SA
authors.lastname: Peters
authors.affiliation: Department of Radiology, Tufts Medical Center, Boston, MA, United States of America.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Polak
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Jacqueline F
authors.initials: JF
authors.lastname: Price
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: Christine
authors.initials: C
authors.lastname: Robertson
authors.affiliation: Cardiology Division, Department of Internal Medicine, University of Virginia, Charlottesville, VA, United States of America.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Rembold
authors.affiliation: Dept of Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Malmö, Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Rosvall
authors.affiliation: Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, United States of America.
authors.forename: Tatjana
authors.initials: T
authors.lastname: Rundek
authors.affiliation: MAS-Metabolic Analytical Services Oy, Helsinki, Finland.
authors.forename: Jukka T
authors.initials: JT
authors.lastname: Salonen
authors.affiliation: Department of Neurology, University Hospital, Goethe-University, Frankfurt am Main, Germany and Department of Neurology Klinikum Herford, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Sitzer
authors.affiliation: Department of Internal Medicine and Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Coen D A
authors.initials: CD
authors.lastname: Stehouwer
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Michiel L
authors.initials: ML
authors.lastname: Bots
authors.affiliation: Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Hester M
authors.initials: HM
authors.lastname: den Ruijter
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D002340:Carotid Artery Diseases / Q000208:ethnology* / Q000473:pathology; D059168:Carotid Intima-Media Thickness; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000208:ethnology; D050171:Dyslipidemias / Q000208:ethnology; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D014943:Global Health; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000208:ethnology; D015994:Incidence; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000208:ethnology* / Q000473:pathology; D015995:Prevalence; D016016:Proportional Hazards Models; D044469:Racial Groups; D012307:Risk Factors; D012907:Smoking / Q000208:ethnology; D020521:Stroke / Q000208:ethnology* / Q000473:pathology
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL