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. 2026 Mar 3.
doi: 10.1186/s12916-026-04739-6. Online ahead of print.

Ethnic differences in the burden of cardiovascular disease risk factors among adult residents of London: the TOGETHER study

Fotios Barkas  1   2 , Malo Dirou  1 , Kanika I Dharmayat  1 , Mahsa Mazidi  3 , Antonio J Vallejo-Vaz  1   4   5   6 , Christophe A T Stevens  1 , Amany Elshorbagy  1   7 , Kausik K Ray  8
Affiliations
Free article

Ethnic differences in the burden of cardiovascular disease risk factors among adult residents of London: the TOGETHER study

Fotios Barkas et al. BMC Med. .
Free article

Abstract

Background: Cardiovascular disease (CVD) remains the leading cause of premature death in England, with ethnic minority populations disproportionately affected, largely due to differences in socioeconomic factors, exposure and/or susceptibility to CVD risk factors. Midlife risk assessment does not fully account for observed variation in CVD incidence and mortality. Early and precise quantification of risk factor burden across diverse populations is therefore essential to inform targeted prevention strategies. This study assessed the prevalence of CVD risk factors in apparently healthy individuals residing in London.

Methods: This cross-sectional study included CVD-free individuals aged 30-90 years residing in London and registered with general practices using the Egton Medical Information Systems (EMIS) electronic health record system. Unadjusted, crude estimates of traditional CVD risk factors were assessed across participants of different ethnicities who underwent a CVD risk assessment between 2009-2020.

Results: Among 607,327 registered individuals, 83,414 were included (52.0% women, median age 45 [IQR:36-48] years). Ethnic distribution was as follows: White (43.6%), Asian (30.1%), Black (9.7%), Chinese/Other (4.0%), Mixed (2.1%). Overall, 7.8% were current smokers, 31.5% had obesity (universally defined as body mass index (BMI) ≥ 30.0 kg/m2), 48.5% had elevated blood pressure (BP ≥ 140/90 mmHg), 44.9% had hypercholesterolemia (≥ 5.0 mmol/l), 28.2% had elevated triglycerides (TG) ≥ 1.7 mmol/l, and 25.9% had low high-density lipoprotein cholesterol (HDL-C < 1.0/1.3 mmol/l for males/females, respectively). Smoking prevalence was highest among White individuals (9.7%). Obesity prevalence varied across groups, with higher proportions in Black participants (42.3%) and lower in Asian individuals (26.1%). Elevated BP was recorded more frequently in Mixed (54.9%) and Black (53.0%) participants and less frequently in those classified as Chinese/Other (42.7%). Total cholesterol ≥ 5.0 mmol/L was more commonly documented in Mixed (56.8%) and White (49.8%) participants. Higher proportions of Asian individuals had elevated TG (30.9%) and low HDL-C (31.6%), while corresponding proportions were lower among Black participants (14.4% and 19.5%, respectively).

Conclusions: This large-scale analysis of a diverse population suggests variation in CVD risk factor burden among relatively young individuals without CVD. While not implying causality, these findings reflect inequalities between ethnic groups and support an appraisal of early, tailored, and equitable public health policies to improve CVD risk management across diverse populations.

Keywords: Cardiovascular disease; Diabetes; Dyslipidemia; Ethnicity; Health check; Hypertension; Obesity; Race; Risk factors.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The TOGETHER study protocol received ethical approval (Ref: 17-ES-0104) from the Joint Research Compliance Office and the Imperial College Research Ethics Committee (Imperial College London, UK). Participation by general practices required Research and Development (R&D) approval from the respective NHS Trusts. The study adhered to the ethical principles of the Declaration of Helsinki. Consent to release patient-level data was sought directly from participating GPs. Upon receiving consent to participate in research, patient-level data were extracted directly from the central EMIS data warehouse. Consent for publication: All authors have reviewed and approved the final version of the manuscript and consent to its publication. Competing interests: F. Barkas has received research grants from Amgen, Boehringer Ingelheim, Eli Lilly, Novartis, Novo Nordisk and honoraria from Menarini Hellas, Novartis, Novo Nordisk, Sanofi and Viatris. A.J. Vallejo‐Vaz reports past or current participation in research grants to Imperial College London from Pfizer, Amgen, Merck Sharp & Dohme, Sanofi, Daiichi Sankyo, and Regeneron, outside the submitted work; personal fees for consulting from Bayer and Regeneron outside the submitted work; and acknowledges support from the Programme “Beatriz Galindo” from the Ministry of Universities, Spain, and University of Seville, Spain. C.A.T Stevens reports grants from Pfizer, Amgen, Merck Sharp & Dohme, Novartis, Sanofi, Daiichi Sankyo, and Regeneron, during the conduct of the study. K. Ray reports research grants from Amgen, Amarin, Sanofi, Daiichi-Sankyo, and Ultragenyx to Imperial College London; consultant fees from Novartis, Daiichi-Sankyo, Kowa, Esperion, Novo Nordisk, MSD, Eli Lilly, Silence Therapeutics, AstraZeneca, NewAmsterdam Pharma, Bayer, Beren Therapeutics, Cleerly, EmendoBio, Scribe, Nodthera, Crispr, Vaxxinity, and Sanofi; lecture fees from Novartis, Boehringer Ingelheim, AstraZeneca, Novo Nordisk, Viatris, Amarin, Sanofi, Amgen, Esperion, Daiichi-Sankyo, Dr. Reddys, and Mankind; fees from Macleod Pharma for symposia at international meetings; stock options in NewAmsterdam Pharma, Scribe Therapeutics, and Pemi31; and serving as past EAS President (unpaid). All other authors declare that they have no competing interests. Funding: The TOGETHER study was supported through investigator-initiated research grants to the Imperial College London from Regeneron Pharmaceuticals and Sanofi.

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