Quantifying and Understanding the Higher Risk of Atherosclerotic Cardiovascular Disease Among South Asian Individuals: Results From the UK Biobank Prospective Cohort Study.
Quantifying and Understanding the Higher Risk of Atherosclerotic Cardiovascular Disease Among South Asian Individuals: Results From the UK Biobank Prospective Cohort Study.
复制标题
量化和了解南亚人群中动脉粥样硬化性心血管疾病的高风险：英国生物库前瞻性队列研究的结果。
DOI：
10.1161/circulationaha.120.052430
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发表时间：
2021-08-10
期刊：
影响因子：
37.8
通讯作者：
Khera AV
中科院分区：
文献类型：
--
作者：
Patel AP;Wang M;Kartoun U;Ng K;Khera AV
南亚血统的人占全球人口的23%，相当于18亿人，与大多数其他种族相比，他们患动脉粥样硬化性心血管疾病的风险要高得多。美国的实践指南现在承认南亚血统是一个重要的“风险增加”因素。在当代临床护理的背景下，风险增加的程度，现有风险评估器所捕获的程度，以及其潜在的机制值得进一步研究。在英国生物银行前瞻性队列研究中，8,124名南亚血统的中年参与者和449,349名欧洲血统的参与者在入组时没有动脉粥样硬化性心血管疾病。祖先与动脉粥样硬化性心血管疾病（定义为心肌梗死、冠状动脉血运重建或缺血性中风）发生风险的关系，采用Cox比例风险回归，以及广泛的临床、人体测量和生活方式介质的检查进行评估。研究入组时的平均年龄为57岁，202,405人（44%）为男性。在11年的中位随访中，8,124名南亚血统的个体中有554名（6.8%）发生了动脉粥样硬化性心血管疾病事件，而449,349名欧洲血统的个体中有19,756名（4.4%）发生了动脉粥样硬化性心血管疾病事件，相应的校正风险比为2.03 （95%CI 1.86-2.22； P<0.001）。这种较高的相对风险在不同年龄、性别和临床亚组中基本一致。尽管观察到的风险高出2倍，但根据AHA/ACC合并队列方程和QRISK3方程，南亚和欧洲血统个体的10年心血管疾病预测风险几乎相同。对广泛的临床、人体测量和生活方式危险因素进行调整后，观察到的危险比仅适度下降至1.45 （95%CI 1.28-1.65， P<0.001）。由18个候选危险因素解释的方差分析表明，南亚人高血压、糖尿病和中心性肥胖的重要性更高。在一项大型前瞻性研究中，与欧洲血统的个体相比，南亚个体患动脉粥样硬化性心血管疾病的风险要高得多，而这一风险并未被合并队列方程所捕获。
Individuals of South Asian ancestry represent 23% of the global population – corresponding to 1.8 billion people – and suffer from substantially higher risk of atherosclerotic cardiovascular disease compared with most other ethnicities. U.S. practice guidelines now recognize South Asian ancestry as an important ‘risk-enhancing’ factor. The magnitude of enhanced risk within the context of contemporary clinical care, extent to which it is captured by existing risk estimators, and its potential mechanisms warrant additional study. Within the UK Biobank prospective cohort study, 8,124 middle-aged participants of South Asian ancestry and 449,349 participants of European ancestry who were free of atherosclerotic cardiovascular disease at time of enrollment were examined. The relationship of ancestry to risk of incident atherosclerotic cardiovascular disease – defined as myocardial infarction, coronary revascularization, or ischemic stroke – was assessed using Cox proportional hazards regression, along with examination of a broad range of clinical, anthropometric, and lifestyle mediators. Mean age at study enrollment was 57 years and 202,405 (44%) were male. Over a median follow-up of 11 years, 554 of 8,124 (6.8%) individuals of South Asian ancestry experienced an atherosclerotic cardiovascular disease event, compared with 19,756 of 449,349 (4.4%) individuals of European ancestry, corresponding to an adjusted hazard ratio of 2.03 (95%CI 1.86–2.22; P<0.001). This higher relative risk was largely consistent across a range of age, sex, and clinical subgroups. Despite the >2-fold higher observed risk, the predicted 10-year risk of cardiovascular disease according to the AHA/ACC Pooled Cohort Equations and QRISK3 equations was nearly identical for South Asian and European ancestry individuals. Adjustment for a broad range of clinical, anthropometric, and lifestyle risk factors led to only modest attenuation of the observed hazard ratio to 1.45 (95%CI 1.28–1.65, P<0.001). Analysis of variance explained by eighteen candidate risk factors suggested higher importance of hypertension, diabetes, and central adiposity in South Asians. Within a large prospective study, South Asian individuals had substantially higher risk of atherosclerotic cardiovascular disease as compared with individuals of European ancestry, and this risk was not captured by the Pooled Cohort Equations.