Key result
Healthy South Asians show lower iliofemoral atheroma burden and LV mass than Western Europeans.
Why the study?
South Asians have a higher risk of cardiovascular disease but paradoxically lower prevalence of peripheral arterial disease compared with Western Europeans, and the feasibility of whole-body cardiovascular MRI to compare these groups was unknown.
Does whole-body cardiovascular MRI detect differences in atherosclerotic burden and cardiac remodelling between healthy South Asian and Western European adults?
Cross-Sectional (n=57)
Does whole-body cardiovascular MRI detect differences in atherosclerotic burden and cardiac remodelling between healthy South Asian and Western European adults?
Absolute Event Rate: 0% vs 1.9%
p-value: p=0.048
Whole-body cardiovascular MRI demonstrates that healthy South Asians have lower iliofemoral atheroma burden and smaller indexed left ventricular mass compared to matched Western Europeans, suggesting their higher CVD risk may relate to adverse cardiac hemodynamics rather than increased atherosclerosis.
These observations should not yet influence practice; leaves open questions about ethnic differences in subclinical cardiovascular disease.
OBJECTIVE: To determine the feasibility of using whole-body cardiovascular MRI (WB-CVMR) to compare South Asians (SAs)-a population known to have a higher risk of cardiovascular disease (CVD) but paradoxically lower prevalence of peripheral arterial disease-and Western Europeans (WEs). METHODS: 19 SAs and 38 age-, gender- and body mass index-matched WEs were recruited. All were aged 40 years and over, free from CVD and with a 10-year risk of CVD <20% as assessed by the adult treatment panel (ATP) III risk score. WB-CVMR was performed, comprising a whole-body angiogram (WBA) and cardiac MR (CMR), on a 3-T MRI scanner (Magnetom(®) Trio; Siemens, Erlangen, Germany) following dual-phase injection of gadolinium-based contrast agent. A standardized atheroma score (SAS) was calculated from the WBA while indexed left ventricular mass and volumes were calculated from the CMR. RESULTS: SAs exhibited a significantly lower iliofemoral atheroma burden (regional SAS 0.0 ± 0.0 vs 1.9 ± 6.9, p = 0.048) and a trend towards lower overall atheroma burden (whole-body SAS 0.7 ± 0.8 vs 1.8 ± 2.3, p = 0.1). They had significantly lower indexed left ventricular mass (46.9 ± 11.8 vs 56.9 ± 13.4 ml m(-2), p = 0.008), end diastolic volume (63.9 ± 10.4 vs 75.2 ± 11.4 ml m(-2), p=0.001), end systolic volume (20.5 ± 6.1 vs 24.6 ± 6.8 ml m(-2), p = 0.03) and stroke volume (43.4 ± 6.6 vs 50.6 ± 7.9 ml m(-2), p = 0.001), but with no significant difference in ejection fraction, mass-volume ratio or global functioning index. These differences persisted after accounting for CVD risk factors. CONCLUSION: WB-CVMR can quantify cardiac and atheroma burden and can detect differences in these metrics between ethnic groups that, if validated, may suggest that the paradoxical high risk of CVD compared with PVD risk may be due to an adverse cardiac haemodynamic status incurred by the smaller heart rather than atherosclerosis. ADVANCES IN KNOWLEDGE: WB-CVMR can be used to stratify and compare disease between ethnicities.
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Weir‐McCall et al. (2016) conducted a cross-sectional in Healthy (n=57). South Asian ethnicity vs. Western European ethnicity was evaluated on Iliofemoral atheroma burden (regional SAS) (p=0.048). Compared to Western Europeans, healthy South Asian adults had significantly lower iliofemoral atheroma burden (0.0 vs 1.9, p=0.048) and indexed left ventricular mass (46.9 vs 56.9, p=0.008).
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