Race/ethnic differences in the associations of the Framingham risk factors with carotid IMT and cardiovascular events

Crystel M. Gijsberts, Karlijn A. Groenewegen, Imo E. Hoefer, Marinus J C Eijkemans, Folkert W. Asselbergs, Todd J. Anderson, Annie R. Britton, Jacqueline M. Dekker, Gunnar Engström, Greg W. Evans, Jacqueline De Graaf, Diederick E. Grobbee, Bo Hedblad, Suzanne Holewijn, Ai Ikeda, Kazuo Kitagawa, Akihiko Kitamura, Dominique P V De Kleijn, Eva M. Lonn, Matthias W. LorenzEllisiv B. Mathiesen, Giel Nijpels, Shuhei Okazaki, Daniel H. O'Leary, Gerard Pasterkamp, Sanne A E Peters, Joseph F. Polak, Jacqueline F. Price, Christine Robertson, Christopher M. Rembold, Maria Rosvall, Tatjana Rundek, Jukka T. Salonen, Matthias Sitzer, Coen D A Stehouwer, Michiel L. Bots, Hester M. Den Ruijter

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Background: Clinical manifestations and outcomes of atherosclerotic disease differ between ethnic groups. In addition, the prevalence of risk factors is substantially different. Primary prevention programs are based on data derived from almost exclusively White people. We investigated how race/ethnic differences modify the associations of established risk factors with atherosclerosis and cardiovascular events. Methods: We used data from an ongoing individual participant meta-analysis involving 17 population-based cohorts worldwide. We selected 60,211 participants without cardiovascular disease at baseline with available data on ethnicity (White, Black, Asian or Hispanic). We generated a multivariable linear regression model containing risk factors and ethnicity predicting mean common carotid intima-media thickness (CIMT) and a multivariable Cox regression model predicting myocardial infarction or stroke. For each risk factor we assessed how the association with the preclinical and clinical measures of cardiovascular atherosclerotic disease was affected by ethnicity. Results: Ethnicity appeared to significantly modify the associations between risk factors and CIMT and cardiovascular events. The association between age and CIMT was weaker in Blacks and Hispanics. Systolic blood pressure associated more strongly with CIMT in Asians. HDL cholesterol and smoking associated less with CIMT in Blacks. Furthermore, the association of age and total cholesterol levels with the occurrence of cardiovascular events differed between Blacks and Whites. Conclusion: The magnitude of associations between risk factors and the presence of atherosclerotic disease differs between race/ethnic groups. These subtle, yet significant differences provide insight in the etiology of cardiovascular disease among race/ethnic groups. These insights aid the race/ethnic-specific implementation of primary prevention.

Original languageEnglish (US)
Article numbere0132321
JournalPLoS One
Volume10
Issue number7
DOIs
StatePublished - Jul 2 2015

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ethnic differences
Carotid Intima-Media Thickness
nationalities and ethnic groups
risk factors
atherosclerosis
Ethnic Groups
Cardiovascular Diseases
Primary Prevention
Hispanic Americans
Linear Models
cardiovascular diseases
Blood Pressure
Blood pressure
Proportional Hazards Models
Linear regression
myocardial infarction
systolic blood pressure
HDL Cholesterol
Meta-Analysis
stroke

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Gijsberts, C. M., Groenewegen, K. A., Hoefer, I. E., Eijkemans, M. J. C., Asselbergs, F. W., Anderson, T. J., ... Den Ruijter, H. M. (2015). Race/ethnic differences in the associations of the Framingham risk factors with carotid IMT and cardiovascular events. PLoS One, 10(7), [e0132321]. https://doi.org/10.1371/journal.pone.0132321

Race/ethnic differences in the associations of the Framingham risk factors with carotid IMT and cardiovascular events. / Gijsberts, Crystel M.; Groenewegen, Karlijn A.; Hoefer, Imo E.; Eijkemans, Marinus J C; Asselbergs, Folkert W.; Anderson, Todd J.; Britton, Annie R.; Dekker, Jacqueline M.; Engström, Gunnar; Evans, Greg W.; De Graaf, Jacqueline; Grobbee, Diederick E.; Hedblad, Bo; Holewijn, Suzanne; Ikeda, Ai; Kitagawa, Kazuo; Kitamura, Akihiko; De Kleijn, Dominique P V; Lonn, Eva M.; Lorenz, Matthias W.; Mathiesen, Ellisiv B.; Nijpels, Giel; Okazaki, Shuhei; O'Leary, Daniel H.; Pasterkamp, Gerard; Peters, Sanne A E; Polak, Joseph F.; Price, Jacqueline F.; Robertson, Christine; Rembold, Christopher M.; Rosvall, Maria; Rundek, Tatjana; Salonen, Jukka T.; Sitzer, Matthias; Stehouwer, Coen D A; Bots, Michiel L.; Den Ruijter, Hester M.

In: PLoS One, Vol. 10, No. 7, e0132321, 02.07.2015.

Research output: Contribution to journalArticle

Gijsberts, CM, Groenewegen, KA, Hoefer, IE, Eijkemans, MJC, Asselbergs, FW, Anderson, TJ, Britton, AR, Dekker, JM, Engström, G, Evans, GW, De Graaf, J, Grobbee, DE, Hedblad, B, Holewijn, S, Ikeda, A, Kitagawa, K, Kitamura, A, De Kleijn, DPV, Lonn, EM, Lorenz, MW, Mathiesen, EB, Nijpels, G, Okazaki, S, O'Leary, DH, Pasterkamp, G, Peters, SAE, Polak, JF, Price, JF, Robertson, C, Rembold, CM, Rosvall, M, Rundek, T, Salonen, JT, Sitzer, M, Stehouwer, CDA, Bots, ML & Den Ruijter, HM 2015, 'Race/ethnic differences in the associations of the Framingham risk factors with carotid IMT and cardiovascular events', PLoS One, vol. 10, no. 7, e0132321. https://doi.org/10.1371/journal.pone.0132321
Gijsberts CM, Groenewegen KA, Hoefer IE, Eijkemans MJC, Asselbergs FW, Anderson TJ et al. Race/ethnic differences in the associations of the Framingham risk factors with carotid IMT and cardiovascular events. PLoS One. 2015 Jul 2;10(7). e0132321. https://doi.org/10.1371/journal.pone.0132321
Gijsberts, Crystel M. ; Groenewegen, Karlijn A. ; Hoefer, Imo E. ; Eijkemans, Marinus J C ; Asselbergs, Folkert W. ; Anderson, Todd J. ; Britton, Annie R. ; Dekker, Jacqueline M. ; Engström, Gunnar ; Evans, Greg W. ; De Graaf, Jacqueline ; Grobbee, Diederick E. ; Hedblad, Bo ; Holewijn, Suzanne ; Ikeda, Ai ; Kitagawa, Kazuo ; Kitamura, Akihiko ; De Kleijn, Dominique P V ; Lonn, Eva M. ; Lorenz, Matthias W. ; Mathiesen, Ellisiv B. ; Nijpels, Giel ; Okazaki, Shuhei ; O'Leary, Daniel H. ; Pasterkamp, Gerard ; Peters, Sanne A E ; Polak, Joseph F. ; Price, Jacqueline F. ; Robertson, Christine ; Rembold, Christopher M. ; Rosvall, Maria ; Rundek, Tatjana ; Salonen, Jukka T. ; Sitzer, Matthias ; Stehouwer, Coen D A ; Bots, Michiel L. ; Den Ruijter, Hester M. / Race/ethnic differences in the associations of the Framingham risk factors with carotid IMT and cardiovascular events. In: PLoS One. 2015 ; Vol. 10, No. 7.
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abstract = "Background: Clinical manifestations and outcomes of atherosclerotic disease differ between ethnic groups. In addition, the prevalence of risk factors is substantially different. Primary prevention programs are based on data derived from almost exclusively White people. We investigated how race/ethnic differences modify the associations of established risk factors with atherosclerosis and cardiovascular events. Methods: We used data from an ongoing individual participant meta-analysis involving 17 population-based cohorts worldwide. We selected 60,211 participants without cardiovascular disease at baseline with available data on ethnicity (White, Black, Asian or Hispanic). We generated a multivariable linear regression model containing risk factors and ethnicity predicting mean common carotid intima-media thickness (CIMT) and a multivariable Cox regression model predicting myocardial infarction or stroke. For each risk factor we assessed how the association with the preclinical and clinical measures of cardiovascular atherosclerotic disease was affected by ethnicity. Results: Ethnicity appeared to significantly modify the associations between risk factors and CIMT and cardiovascular events. The association between age and CIMT was weaker in Blacks and Hispanics. Systolic blood pressure associated more strongly with CIMT in Asians. HDL cholesterol and smoking associated less with CIMT in Blacks. Furthermore, the association of age and total cholesterol levels with the occurrence of cardiovascular events differed between Blacks and Whites. Conclusion: The magnitude of associations between risk factors and the presence of atherosclerotic disease differs between race/ethnic groups. These subtle, yet significant differences provide insight in the etiology of cardiovascular disease among race/ethnic groups. These insights aid the race/ethnic-specific implementation of primary prevention.",
author = "Gijsberts, {Crystel M.} and Groenewegen, {Karlijn A.} and Hoefer, {Imo E.} and Eijkemans, {Marinus J C} and Asselbergs, {Folkert W.} and Anderson, {Todd J.} and Britton, {Annie R.} and Dekker, {Jacqueline M.} and Gunnar Engstr{\"o}m and Evans, {Greg W.} and {De Graaf}, Jacqueline and Grobbee, {Diederick E.} and Bo Hedblad and Suzanne Holewijn and Ai Ikeda and Kazuo Kitagawa and Akihiko Kitamura and {De Kleijn}, {Dominique P V} and Lonn, {Eva M.} and Lorenz, {Matthias W.} and Mathiesen, {Ellisiv B.} and Giel Nijpels and Shuhei Okazaki and O'Leary, {Daniel H.} and Gerard Pasterkamp and Peters, {Sanne A E} and Polak, {Joseph F.} and Price, {Jacqueline F.} and Christine Robertson and Rembold, {Christopher M.} and Maria Rosvall and Tatjana Rundek and Salonen, {Jukka T.} and Matthias Sitzer and Stehouwer, {Coen D A} and Bots, {Michiel L.} and {Den Ruijter}, {Hester M.}",
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T1 - Race/ethnic differences in the associations of the Framingham risk factors with carotid IMT and cardiovascular events

AU - Gijsberts, Crystel M.

AU - Groenewegen, Karlijn A.

AU - Hoefer, Imo E.

AU - Eijkemans, Marinus J C

AU - Asselbergs, Folkert W.

AU - Anderson, Todd J.

AU - Britton, Annie R.

AU - Dekker, Jacqueline M.

AU - Engström, Gunnar

AU - Evans, Greg W.

AU - De Graaf, Jacqueline

AU - Grobbee, Diederick E.

AU - Hedblad, Bo

AU - Holewijn, Suzanne

AU - Ikeda, Ai

AU - Kitagawa, Kazuo

AU - Kitamura, Akihiko

AU - De Kleijn, Dominique P V

AU - Lonn, Eva M.

AU - Lorenz, Matthias W.

AU - Mathiesen, Ellisiv B.

AU - Nijpels, Giel

AU - Okazaki, Shuhei

AU - O'Leary, Daniel H.

AU - Pasterkamp, Gerard

AU - Peters, Sanne A E

AU - Polak, Joseph F.

AU - Price, Jacqueline F.

AU - Robertson, Christine

AU - Rembold, Christopher M.

AU - Rosvall, Maria

AU - Rundek, Tatjana

AU - Salonen, Jukka T.

AU - Sitzer, Matthias

AU - Stehouwer, Coen D A

AU - Bots, Michiel L.

AU - Den Ruijter, Hester M.

PY - 2015/7/2

Y1 - 2015/7/2

N2 - Background: Clinical manifestations and outcomes of atherosclerotic disease differ between ethnic groups. In addition, the prevalence of risk factors is substantially different. Primary prevention programs are based on data derived from almost exclusively White people. We investigated how race/ethnic differences modify the associations of established risk factors with atherosclerosis and cardiovascular events. Methods: We used data from an ongoing individual participant meta-analysis involving 17 population-based cohorts worldwide. We selected 60,211 participants without cardiovascular disease at baseline with available data on ethnicity (White, Black, Asian or Hispanic). We generated a multivariable linear regression model containing risk factors and ethnicity predicting mean common carotid intima-media thickness (CIMT) and a multivariable Cox regression model predicting myocardial infarction or stroke. For each risk factor we assessed how the association with the preclinical and clinical measures of cardiovascular atherosclerotic disease was affected by ethnicity. Results: Ethnicity appeared to significantly modify the associations between risk factors and CIMT and cardiovascular events. The association between age and CIMT was weaker in Blacks and Hispanics. Systolic blood pressure associated more strongly with CIMT in Asians. HDL cholesterol and smoking associated less with CIMT in Blacks. Furthermore, the association of age and total cholesterol levels with the occurrence of cardiovascular events differed between Blacks and Whites. Conclusion: The magnitude of associations between risk factors and the presence of atherosclerotic disease differs between race/ethnic groups. These subtle, yet significant differences provide insight in the etiology of cardiovascular disease among race/ethnic groups. These insights aid the race/ethnic-specific implementation of primary prevention.

AB - Background: Clinical manifestations and outcomes of atherosclerotic disease differ between ethnic groups. In addition, the prevalence of risk factors is substantially different. Primary prevention programs are based on data derived from almost exclusively White people. We investigated how race/ethnic differences modify the associations of established risk factors with atherosclerosis and cardiovascular events. Methods: We used data from an ongoing individual participant meta-analysis involving 17 population-based cohorts worldwide. We selected 60,211 participants without cardiovascular disease at baseline with available data on ethnicity (White, Black, Asian or Hispanic). We generated a multivariable linear regression model containing risk factors and ethnicity predicting mean common carotid intima-media thickness (CIMT) and a multivariable Cox regression model predicting myocardial infarction or stroke. For each risk factor we assessed how the association with the preclinical and clinical measures of cardiovascular atherosclerotic disease was affected by ethnicity. Results: Ethnicity appeared to significantly modify the associations between risk factors and CIMT and cardiovascular events. The association between age and CIMT was weaker in Blacks and Hispanics. Systolic blood pressure associated more strongly with CIMT in Asians. HDL cholesterol and smoking associated less with CIMT in Blacks. Furthermore, the association of age and total cholesterol levels with the occurrence of cardiovascular events differed between Blacks and Whites. Conclusion: The magnitude of associations between risk factors and the presence of atherosclerotic disease differs between race/ethnic groups. These subtle, yet significant differences provide insight in the etiology of cardiovascular disease among race/ethnic groups. These insights aid the race/ethnic-specific implementation of primary prevention.

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