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Cardiovascular disease recurrence and long-term mortality in a tri-ethnic British cohort
Manav V Vyas1, Nish Chaturvedi2, Alun D Hughes2
1Division of Neurology, University of Toronto, Toronto, Ontario, Canada.
Insights
Ethnic differences in cardiovascular disease recurrence and mortality were examined in a British cohort. Baseline vascular risk factors eliminated ethnic variations in outcomes, with improved survival observed in minority ethnic groups over time.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Ethnic variations in cardiovascular disease (CVD) incidence are known, but recurrence patterns require further investigation.
- Understanding long-term outcomes after a non-fatal cardiovascular event across diverse ethnic groups is crucial for targeted healthcare.
- Previous studies suggest differing CVD risk profiles among South Asians, African Caribbeans, and Europeans.
Purpose of the Study:
- To characterize the long-term risk of major adverse cardiovascular events (MACE) and mortality following an initial non-fatal cardiovascular event.
- To compare these risks between South Asian, African Caribbean, and European individuals within a British cohort.
- To investigate the influence of ethnicity on cardiovascular disease recurrence and long-term survival.
Main Methods:
- A British cohort study identified index and recurrent cardiovascular events and mortality from 1988 to 2017 using hospital records and death registries.
- Multivariable hazards models were employed to calculate adjusted hazard ratios (HR) for MACE and death post-index event.
- Demographics, vascular, and lifestyle risk factors were adjusted for, and interaction terms assessed the modification of ethnic associations by the decade of the index event.
Main Results:
- South Asians were younger at their index event compared to Europeans and African Caribbeans.
- While crude MACE rates were highest in South Asians, adjusted analyses eliminated significant ethnic differences in MACE and mortality risk.
- African Caribbeans showed similar MACE and mortality outcomes compared to Europeans.
- Long-term survival following an index event demonstrated improvement over time in South Asians and African Caribbeans relative to Europeans.
Conclusions:
- Observed ethnic variations in cardiovascular disease recurrence and long-term mortality were explained by baseline vascular risk factors.
- A relative improvement in survival for minority ethnic groups (South Asians and African Caribbeans) was noted over the study period.
- These findings underscore the importance of addressing vascular risk factors to mitigate ethnic disparities in cardiovascular outcomes.
Objective:
Ethnic differences in cardiovascular disease incidence, but not cardiovascular disease recurrence, are reported. We characterised long-term risk of major adverse cardiovascular event (MACE) and mortality following a non-fatal cardiovascular event in a British cohort of South Asians, African Caribbeans and Europeans.
Methods:
We identified index and recurrent cardiovascular events and mortality between 1988 and 2017 using hospital records and death registry. Using multivariable hazards models, we separately calculated the adjusted HR of MACE and death following index event, adjusting for demographics, vascular and lifestyle risk factors. Using interaction terms, we evaluated if decade of index event modified the association between ethnicity and outcomes.
Results:
South Asians were younger at the index event (median age 66 years, n=396) than Europeans (69 years, n=335) and African Caribbeans (70 years, n=70). During 4228 person-years, of the 801 patients, 537 developed MACE and 338 died, with the highest crude rate of MACE in South Asians. On adjustment of baseline factors, compared with the Europeans, the higher risk of MACE (HR 0.97, 95% CI 0.77 to 1.21) and the lower risk of mortality (HR 0.95, 95% CI 0.72 to 1.26) in South Asians was eliminated. African Caribbeans had similar outcomes to Europeans (HR MACE 1.04, 95% CI 0.74 to 1.47; and HR death 1.07, 95% CI 0.70 to 1.64). Long-term survival following an index event improved in South Asians (ptrend 0.02) and African Caribbeans (ptrend 0.07) compared with Europeans.
Conclusions:
Baseline vascular risk factors explained the observed ethnic variation in cardiovascular disease recurrence and long-term mortality, with a relative improvement in survival of minority ethnic groups over time.
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