Ethnic differences in cardiovascular disease
Ethnic differences in cardiovascular disease
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DOI：
10.1136/heart.89.6.681
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发表时间：
2003-06-01
期刊：
影响因子：
5.7
通讯作者：
Chaturvedi, N
中科院分区：
文献类型：
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作者：
Chaturvedi, N
非欧洲血统的人约占英国总人口的7%。其中大多数是南亚人（即来自印度次大陆）或黑非洲人（即来自加勒比和西非）的后裔。对于这些移民来说，就像生活在西方世界的几乎所有人口群体一样，心血管疾病是主要的死亡原因。但CVD风险存在显著的种族差异。疾病表现可能不同，挑战诊断技能，治疗要求和反应也可能不一致。CVD种族差异的研究不仅为少数民族群体，而且为大多数人口提供了有价值的病因学线索。c南亚的缺血性心脏病全世界南亚裔移民因缺血性心脏病（IHD）而发生病态和致命事件的风险增加。1在英国，南亚男性和女性的IHD死亡率是一般人群的1.5倍（图1），2在过去几十年中，南亚人并没有从IHD导致的死亡率普遍下降中获得同样程度的好处。这些种族差异在最年轻的年龄组中最大。这些种族差异已被广泛研究，而经典的危险因素，如吸烟，血压，肥胖，和胆固醇在南亚亚群之间差异很大，在某些情况下，水平相当于或低于欧洲人口，葡萄糖耐受不良，中心性肥胖，（通过腰臀比测量），空腹甘油三酯和胰岛素与欧洲人相比均匀升高（表1）。3由于所有南亚亚组都有IHD的高风险，很明显，后一组因素可能是南亚人易患IHD的原因。这些因素是胰岛素抵抗综合征的关键特征，胰岛素抵抗综合征是一组代谢紊乱，包括高胰岛素血症、高脂血症和相关的明显糖尿病，以及血脂异常，其特征在于甘油三酯升高和高密度脂蛋白（HDL）胆固醇浓度降低。4在其他人群中探索胰岛素抵抗预测能力的队列研究一直存在矛盾，虽然横断面数据分析表明胰岛素抵抗可能是南亚人IHD风险增加的主要原因，但目前缺乏胰岛素抵抗基线指标与IHD结局相关的队列数据形式的明确证据。胰岛素抵抗在南亚人冠心病病因学中的潜在重要性促使研究人员探索这种关联的确切机制的线索。注意力集中在炎症、感染、止血因子和内皮功能障碍上。C反应蛋白（CRP）浓度在南亚人中升高，至少部分是由更大程度的中心性肥胖引起的，这促进了CRP的表达。5 CRP与空腹和负荷后胰岛素高度相关，并独立预测IHD的风险。派-1和同型半胱氨酸浓度也在南亚人中升高，内皮功能受损;这些也可能导致IHD风险升高，与胰岛素抵抗相关或独立。5–7
People of non-European origin form around 7% of the total UK population. Most of these are of South Asian (that is, from the Indian subcontinent) or Black African (that is, from the Caribbean and West Africa) descent. For these migrants, as for virtually all population groups living in the western world, cardiovascular disease (CVD) is the main cause of death. But there are striking ethnic differences in CVD risk. Disease presentation may differ, challenging diagnostic skills, and therapeutic requirements and responses may also not be uniform. The study of ethnic differences in CVD has provided valuable aetiological clues, not just for ethnic minority groups but also for the majority population. c ISCHAEMIC HEART DISEASE IN SOUTH ASIANSMigrants of South Asian descent worldwide have elevated risks of morbid and mortal events because of ischaemic heart disease (IHD). 1 In the UK, mortality from IHD in both South Asian men and women is 1.5 times that of the general population (fig 1), 2 and South Asians have not benefited to the same extent from the general decline in deaths caused by IHD over the last few decades. These ethnic differences are greatest in the youngest age groups. These ethnic differences have been extensively studied, and while classical risk factors, such as smoking, blood pressure, obesity, and cholesterol vary substantially between subgroups of South Asians—such that in some cases, levels are equivalent to, or lower than, a comparable European population—levels of glucose intolerance, central obesity (as measured by waist to hip ratio), fasting triglyceride, and insulin are uniformly elevated compared to Europeans (table 1). 3 As the elevated risk of IHD is shared by all South Asian subgroups, it is clear that it is the latter group of factors which are likely to account for the susceptibility of South Asians to IHD. These factors are key features of the insulin resistance syndrome, a group of metabolic disturbances including hyperinsulinaemia, hyperglycaemia, and associated frank diabetes, and dyslipidaemia, characterised by elevated triglyceride and a reduction in high density lipoprotein (HDL) cholesterol concentrations. 4 Cohort studies in other populations exploring the predictive power of insulin resistance have been conflicting, and while analysis of cross sectional data suggest that insulin resistance could account for much of the enhanced IHD risk in South Asians, definitive evidence, in the form of cohort data relating baseline measures of insulin resistance to IHD outcomes, is currently lacking. The potential importance of insulin resistance in the aetiology of coronary heart disease in South Asians has prompted researchers to explore clues as to the exact mechanisms of such an association. Attention has focused on inflammation, infection, haemostatic factors, and endothelial dysfunction. C reactive protein (CRP) concentrations are elevated in South Asians, caused at least in part by a greater degree of central adiposity which promotes CRP expression. 5 CRP is highly correlated with fasting and post-load insulin, and independently predicts the risk of IHD. PAI-1 and homocysteine concentrations are also raised in South Asians, and endothelial function is impaired; these may also contribute to the elevation in IHD risk, either related to or separately from their associations with insulin resistance. 5–7