Please use this identifier to cite or link to this item: https://doi.org/10.1371/journal.pone.0132278
Title: Ethnicity modifies associations between cardiovascular risk factors and disease severity in parallel Dutch and Singapore coronary cohorts
Authors: Gijsberts C.M.
Seneviratna A.
De Carvalho L.P.
Den Ruijter H.M.
Vidanapthirana P.
Sorokin V. 
Stella P. 
Agostoni P.
Asselbergs F.W.
Richards A.M. 
Low A.F. 
Lee C.-H. 
Tan H.C. 
Hoefer I.E.
Pasterkamp G.
De Kleijn D.P.V. 
Chan M.Y. 
Keywords: antiangina pectoris agent
antithrombocytic agent
beta adrenergic receptor blocking agent
hydroxymethylglutaryl coenzyme A reductase inhibitor
acute coronary syndrome
adult
angiocardiography
Article
body mass
cardiovascular risk
Caucasian
Chinese
controlled study
coronary artery bypass surgery
coronary artery disease
diabetes mellitus
disease severity
dyslipidemia
ethnic difference
female
human
hypertension
Indian
major clinical study
Malay (people)
male
mortality
Netherlands
non ST segment elevation myocardial infarction
parallel design
patient history of coronary artery bypass graft
percutaneous coronary intervention
sex difference
Singapore
smoking
ST segment elevation myocardial infarction
unstable angina pectoris
aged
Asian continental ancestry group
Caucasian
clinical trial
comparative study
coronary angiography
diagnostic imaging
epidemiology
ethnology
middle aged
multicenter study
prospective study
severity of illness index
Aged
Asian Continental Ancestry Group
Coronary Angiography
Coronary Artery Disease
European Continental Ancestry Group
Female
Humans
Male
Middle Aged
Netherlands
Prospective Studies
Severity of Illness Index
Singapore
Issue Date: 2015
Publisher: Public Library of Science
Citation: Gijsberts C.M., Seneviratna A., De Carvalho L.P., Den Ruijter H.M., Vidanapthirana P., Sorokin V., Stella P., Agostoni P., Asselbergs F.W., Richards A.M., Low A.F., Lee C.-H., Tan H.C., Hoefer I.E., Pasterkamp G., De Kleijn D.P.V., Chan M.Y. (2015). Ethnicity modifies associations between cardiovascular risk factors and disease severity in parallel Dutch and Singapore coronary cohorts. PLoS ONE 10 (7) : e0132278. ScholarBank@NUS Repository. https://doi.org/10.1371/journal.pone.0132278
Abstract: Background: In 2020 the largest number of patients with coronary artery disease (CAD) will be found in Asia. Published epidemiological and clinical reports are overwhelmingly derived from western (White) cohorts and data from Asia are scant. We compared CAD severity and all-cause mortality among 4 of the world's most populous ethnicities: Whites, Chinese, Indians and Malays. Methods: The UNIted CORoNary cohort (UNICORN) simultaneously enrolled parallel populations of consecutive patients undergoing coronary angiography or intervention for suspected CAD in the Netherlands and Singapore. Using multivariable ordinal regression, we investigated the independent association of ethnicity with CAD severity and interactions between risk factors and ethnicity on CAD severity. Also, we compared all-cause mortality among the ethnic groups using multivariable Cox regression analysis. Results: We included 1,759 White, 685 Chinese, 201 Indian and 224 Malay patients undergoing coronary angiography. We found distinct inter-ethnic differences in cardiovascular risk factors. Furthermore, the associations of gender and diabetes with severity of CAD were significantly stronger in Chinese than Whites. Chinese (OR 1.3 [1.1-1.7], p = 0.008) and Malay (OR 1.9 [1.4-2.6], p<0.001) ethnicity were independently associated with more severe CAD as compared to White ethnicity. Strikingly, when stratified for diabetes status, we found a significant association of all three Asian ethnic groups as compared to White ethnicity with more severe CAD among diabetics, but not in non-diabetics. Crude all-cause mortality did not differ, but when adjusted for covariates mortality was higher in Malays than the other ethnic groups. Conclusion: In this population of individuals undergoing coronary angiography, ethnicity is independently associated with the severity of CAD and modifies the strength of association between certain risk factors and CAD severity. Furthermore, mortality differs among ethnic groups. Our data provide insight in inter-ethnic differences in CAD risk factors, CAD severity and mortality. Copyright: © 2015 Gijsberts et al.
Source Title: PLoS ONE
URI: https://scholarbank.nus.edu.sg/handle/10635/165690
ISSN: 19326203
DOI: 10.1371/journal.pone.0132278
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