Differences in risk factors, atherosclerosis, and cardiovascular disease between ethnic groups in Canada: the Study of Health Assessment and Risk in Ethnic groups (SHARE)
Differences in risk factors, atherosclerosis, and cardiovascular disease between ethnic groups in Canada: the Study of Health Assessment and Risk in Ethnic groups (SHARE)
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DOI：
10.1016/s0140-6736(00)02502-2
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发表时间：
2000-07-22
期刊：
影响因子：
168.9
通讯作者：
McQueen, M
中科院分区：
文献类型：
--
作者：
Anand, SS;Yusuf, S;McQueen, M
背景：加拿大不同种族的心血管疾病发病率差异很大。为了确定这种变异是否可以用疾病危险因素和亚临床动脉粥样硬化的差异来解释，我们对加拿大的三个种族进行了一项基于人群的研究：南亚人、中国人和欧洲人。方法采用分层随机抽样方法，从汉密尔顿、多伦多和埃德蒙顿3个城市招募985名受试者。临床心血管疾病由病史或心电图结果来定义。b超检测颈动脉粥样硬化。常规（吸烟、高血压、糖尿病、胆固醇升高）和新的危险因素（血栓形成前状态的标志物）被测量。研究发现，在每个种族和总体上，颈动脉粥样硬化的程度与心血管疾病的高患病率相关。与欧洲人和中国人相比，南亚人的动脉粥样硬化患病率最高（分别为11%、5%和2%，p=0.0004）：尽管如此，欧洲人的动脉粥样硬化发生率（最大内膜厚度平均值为0.75 [0.16]mm）高于南亚人（0.72 [0.15]mm）和中国人（0.69 [0.16]mm）。南亚人葡萄糖耐受不良的患病率增加，总胆固醇和低密度脂蛋白胆固醇较高，甘油三酯较高，高密度脂蛋白胆固醇较低，新的危险因素包括纤维蛋白原、同型半胱氨酸、脂蛋白(a)和纤溶酶原激活剂同型半胱氨酸、抑制剂-1浓度较高。尽管不同种族之间的传统和新型危险因素存在差异，但这种差异和动脉粥样硬化程度仅部分解释了南亚人与欧洲人和中国人相比心血管疾病发病率更高的原因。心血管事件风险的增加可能是由于影响斑块破裂的因素，血栓形成因子和动脉粥样硬化之间的相互作用，或尚未发现的危险因素。
Background Cardiovascular disease rates vary greatly between ethnic groups in Canada. To establish whether this variation can be explained by differences in disease risk factors and subclinical atherosclerosis, we undertook a population-based study of three ethnic groups in Canada: South Asians, Chinese, and Europeans.Methods 985 participants were recruited from three cities (Hamilton, Toronto, and Edmonton) by stratified random sampling. Clinical cardiovascular disease was defined by history or electrocardiographic findings. Carotid atherosclerosis was measured with B-mode ultrasonography. Conventional (smoking, hypertension, diabetes, raised cholesterol) and novel risk factors (markers of a prothrombotic state) were measured.Findings Within each ethnic group and overall, the degree of carotid atherosclerosis was associated with a higher prevalence of cardiovascular disease. South Asians had the highest prevalence of this condition compared with Europeans and Chinese (11%, 5%, and 2%, respectively, p=0.0004): Despite this finding, Europeans had more atherosclerosis (mean of the maximum intimal medial thickness 0.75 [0.16] mm) than South Asians (0.72 [0.15] mm), and Chinese (0.69 [0.16] mm). South Asians had an increased prevalence of glucose intolerance, higher total and LDL cholesterol, higher triglycerides, and lower HDL cholesterol, and much greater abnormalities in novel risk factors including higher concentrations of fibrinogen, homocysteine, lipoprotein (a), and plasminogen activator homocysteine, inhibitor-1.Interpretation Although there are differences in conventional and novel risk factors between ethnic groups, this variation and the degree of atherosclerosis only partly explains the higher rates of cardiovascular disease among South Asians compared with Europeans and Chinese. The increased risk of cardiovascular events could be due to factors affecting plaque rupture, the interaction between prothrombotic factors and atherosclerosis, or as yet undiscovered risk factors.