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Meta-Analysis
. 2015 Jul 2;10(7):e0132321.
doi: 10.1371/journal.pone.0132321. eCollection 2015.

Race/Ethnic Differences in the Associations of the Framingham Risk Factors with Carotid IMT and Cardiovascular Events

Crystel M Gijsberts  1 , Karlijn A Groenewegen  2 , Imo E Hoefer  1 , Marinus J C Eijkemans  2 , Folkert W Asselbergs  3 , Todd J Anderson  4 , Annie R Britton  5 , Jacqueline M Dekker  6 , Gunnar Engström  7 , Greg W Evans  8 , Jacqueline de Graaf  9 , Diederick E Grobbee  10 , Bo Hedblad  7 , Suzanne Holewijn  9 , Ai Ikeda  11 , Kazuo Kitagawa  12 , Akihiko Kitamura  11 , Dominique P V de Kleijn  13 , Eva M Lonn  14 , Matthias W Lorenz  15 , Ellisiv B Mathiesen  16 , Giel Nijpels  6 , Shuhei Okazaki  17 , Daniel H O'Leary  18 , Gerard Pasterkamp  19 , Sanne A E Peters  2 , Joseph F Polak  18 , Jacqueline F Price  20 , Christine Robertson  20 , Christopher M Rembold  21 , Maria Rosvall  7 , Tatjana Rundek  22 , Jukka T Salonen  23 , Matthias Sitzer  24 , Coen D A Stehouwer  25 , Michiel L Bots  2 , Hester M den Ruijter  26
Affiliations
Meta-Analysis

Race/Ethnic Differences in the Associations of the Framingham Risk Factors with Carotid IMT and Cardiovascular Events

Crystel M Gijsberts et al. PLoS One. .

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.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Association between risk factors and mean common CIMT, by ethnicity.
Point estimates for betas, lines represent 95% confidence intervals.
Fig 2
Fig 2. Association between risk factors and first-time stroke or myocardial infarction, by ethnicity.
Point estimates for hazard ratio’s, lines represent 95% confidence intervals.
See this image and copyright information in PMC

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