Key result
South Asian ethnicity is linked to ~69% higher CVD risk vs. White ethnicity, driven by adiposity.
Why the study?
Ethnic differences in cardiovascular disease risk have been known for decades, but a systematic exploration of how exposure and susceptibility to risk factors contribute is lacking.
Does South Asian or Black ethnicity increase the risk of cardiovascular disease compared to White ethnicity?
Cohort (n=451,150)
Yes
Does South Asian or Black ethnicity increase the risk of cardiovascular disease compared to White ethnicity?
Hazard Ratio: 1.69 (95% CI 1.59–1.79)
Absolute Event Rate: 116.2% vs 86.2%
p-value: p=<0.0001
Adiposity is a major CVD risk factor across ethnicities, but ethnic inequalities in CVD incidence highlight the need for targeted interventions based on specific risk profiles, such as HbA1c in South Asians.
Supports ethnicity-informed CVD risk assessment; extends observational disparities data but leaves open targeted intervention effects.
BACKGROUND: Ethnic differences in cardiovascular disease (CVD) risk have been known for decades, but a systematic exploration of how exposure and susceptibility to risk factors may contribute is lacking. This study aimed to investigate the potential impact of differential exposure and susceptibility between South Asian, Black, and White individuals. METHODS: This is a population-based prospective cohort study of UK Biobank participants with a median follow-up of 11.3 years. The association between ethnic group and CVD risk was studied. Additional risk factors were then adjusted to examine mediations. Moderation analysis was conducted to identify whether risk factors had a stronger association in the ethnic minority groups. Population attributable fractions were also calculated to quantify the relative contributions of risk factors for each ethnic group. RESULTS: When adjusted for only age and sex, there was a higher risk of CVD among South Asian (n=8815; HR [95% CI] 1.69 [1.59-1.79]) and Black (n=7526; HR [95% CI] 1.12 [1.03-1.22]) compared with White participants (n=434,809). The excess risk of Black participants was completely attenuated following adjustment for deprivation. Compared with White participants, the associations of BMI, triglycerides, and HbA1c with CVD were stronger in South Asians. Adiposity was attributable to the highest proportion of CVD regardless of ethnicity. Smoking had the second largest contribution to CVD among White and Black participants, and HbA1c among South Asian participants. CONCLUSIONS: Adiposity is an important risk factor for CVD regardless of ethnicity. Ethnic inequalities in CVD incidence may be best tackled by targeting interventions according to ethnic differences in risk profiles.
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Ho et al. (2022) conducted a cohort in Cardiovascular disease (n=451,150). South Asian ethnicity vs. White ethnicity was evaluated on Incident cardiovascular disease (CVD death or hospital admission for myocardial infarction, heart failure, or stroke) (HR 1.69, 95% CI 1.59-1.79, p=<0.0001). South Asian and Black ethnicity were associated with higher age- and sex-adjusted cardiovascular disease risk compared to White ethnicity (HR 1.69 and 1.12), with adiposity as the largest contributor.
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