title: Premature Cardiac Aging in South Asian Compared to Afro-Caribbean Subjects in a Community-Based Screening Study.
abstract: People of South Asian (SAs) and African Caribbean (AC) origin have increased cardiovascular morbidity, but underlying mechanisms are poorly understood. Aging is the key predictor of deterioration in diastolic function, which can be assessed by echocardiography using E/e' ratio as a surrogate of left ventricular (LV) filling pressure. The study aimed to assess a possibility of premature cardiac aging in SA and AC subjects.
  
  
  
  We studied 4540 subjects: 2880 SA and 1660 AC subjects. All participants underwent detailed echocardiography, including LV ejection fraction, average septal-lateral E/e', and LV mass index (LVMI). When compared to ACs, SAs were younger, with lower mean LVMI, systolic blood pressure (BP), diastolic BP, and body mass index (BMI), as well as a lower prevalence of hypertension and smoking (P≤0.001 for all). In a multivariate linear regression model including age, sex, ethnicity, BP, heart rate, BMI, waist circumference, LVMI, history of smoking, hypertension, coronary artery disease, diabetes mellitus, medications, SA origin was independently associated with higher E/e' (regression coefficient±standard error, -0.66±0.10; P<0.001, adjusted R2for the model 0.21; P<0.001). Furthermore, SAs had significantly accelerated age-dependent increase in E/e' compared to ACs. On multivariable Cox regression analysis without adjustment for E/e', SA ethnicity was independently predictive of mortality (P=0.04). After additional adjustment for E/e', the ethnicity lost its significance value, whereas E/e' was independently predictive of higher risk of death (P=0.008).
  
  
  
  Premature cardiac aging is evident in SAs and may contribute to high cardiovascular morbidity in this ethnic group, compared to ACs.
authors.affiliation: University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK e.shantsila@bham.ac.uk.
authors.forename: Eduard
authors.initials: E
authors.lastname: Shantsila
authors.affiliation: University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK.
authors.forename: Alena
authors.initials: A
authors.lastname: Shantsila
authors.affiliation: Primary Care Clinical Sciences, University of Birmingham, UK.
authors.forename: Paramjit S
authors.initials: PS
authors.lastname: Gill
authors.affiliation: University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK.
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
mesh_terms: D000367:Age Factors; D000368:Aged; D019588:Aging, Premature / Q000000981:diagnostic imaging / Q000208:ethnology* / Q000503:physiopathology; D001208:Asia; D044466:Asian People; D001459:Bangladesh / Q000208:ethnology; D044383:Black People; D017691:Caribbean Region / Q000208:ethnology; D003971:Diastole; D004452:Echocardiography; D004739:England; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007194:India / Q000208:ethnology; D016014:Linear Models; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D015999:Multivariate Analysis; D009929:Organ Size; D010154:Pakistan / Q000208:ethnology; D016016:Proportional Hazards Models; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D013318:Stroke Volume; D044465:White People
keywords: aging; diastolic dysfunction; ethnicity; hypertension; left ventricular mass index