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Li J, Daida YG, Bacong AM, Rosales AG, Frankland TB, Varga A, Chung S, Fortmann SP, Waitzfelder B, Palaniappan L. Trends in cigarette smoking and the risk of incident cardiovascular disease among Asian American, Pacific Islander, and multiracial populations. Am J Prev Cardiol 2024; 19:100688. [PMID: 39070025 PMCID: PMC11278113 DOI: 10.1016/j.ajpc.2024.100688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 05/15/2024] [Accepted: 06/12/2024] [Indexed: 07/30/2024] Open
Abstract
Background Cardiovascular disease (CVD) is the leading cause of death in the United States, and rates of CVD incidence vary widely by race and ethnicity. Cigarette smoking is associated with increased risk of CVD. The purpose of the study was: 1) to examine smoking prevalence over time across Asian and Pacific Islander (API) and multi-race API subgroups; 2) to determine whether the CVD risk associated with smoking differed among these subgroups. Methods We identified patients belonging to 7 single race/ethnicity groups, 4 multi-race/ethnicity groups, and a non-Hispanic White (NHW) comparison group at two large health systems in Hawaii and California. We estimated annual smoking prevalence from 2011 through 2018 by group and gender. We examined incidence of CVD events by smoking status and race/ethnicity, and computed hazard ratios for CVD events by age, gender, race/ethnicity, census block median household income, census block college degree, and study site using Cox regression. Results Of the 12 groups studied, the Asian Indian and Chinese American groups had the lowest smoking prevalence, and the Asian + Pacific Islander multiracial group had the highest smoking prevalence. The prevalence of smoking decreased from 2011 to 2018 for all groups. Multi-race/ethnicity groups had higher risk of CVD than the NHW group. There was no significant interaction between race/ethnicity and smoking in models predicting CVD, but the association between race/ethnicity and CVD incidence was attenuated after adjusting for smoking status. Conclusions There is considerable heterogeneity in smoking prevalence and the risk of CVD among API subgroups.
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Affiliation(s)
- Jiang Li
- Sutter Health Center for Health Systems Research/Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
| | - Yihe G. Daida
- Center for Integrated Health Care Research, Kaiser Permanente Hawaii, USA
| | | | | | | | - Alexandra Varga
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Sukyung Chung
- Sutter Health Center for Health Systems Research/Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
| | | | - Beth Waitzfelder
- Center for Integrated Health Care Research, Kaiser Permanente Hawaii, USA
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Xie WM, Ran LS, Jiang J, Chen YS, Ji HY, Quan XQ. Association between fetuin-A and prognosis of CAD: A systematic review and meta-analysis. Eur J Clin Invest 2019; 49:e13091. [PMID: 30793296 DOI: 10.1111/eci.13091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 02/16/2019] [Accepted: 02/19/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Fetuin-A is an anti-inflammation and anti-calcification factor involved in the course of coronary artery disease (CAD). But the association between serum fetuin-A level and the prognosis of CAD patients was still controversial. To clarify the association between serum fetuin-A level and the prognosis of CAD patients, we conducted the present meta-analysis. METHODS The included studies should be potentially relevant prospective studies published in English language before January 2019. The target population of the present meta-analysis was restricted to patients with CAD. The results of studies must report hazard ratio (HR) or Kaplan-Meier survival curve for all-cause mortality or incidence of secondary cardiovascular disease (CVD) events. The pooled HRs were analysed by the method of meta-analysis. RESULTS A total of four prospective studies, including 4256 participants with CAD disease, were chosen to be included. The pooled HR for all-cause mortality was 0.57 (95% CI: 0.37-0.87), showing a statistically significant association between high serum fetuin-A level and low all-cause mortality in CAD patients. For the incidence of secondary CVD events, the pooled HR was 0.86 (95% CI: 0.60-1.23), indicating no statistically significant association between serum fetuin-A level and incidence of secondary CVD events in CAD patients. CONCLUSION High serum fetuin-A level associated with lower all-cause mortality in patients with CAD. No association between serum fetuin-A level and incidence of secondary CVD events was found in patients with CAD.
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Affiliation(s)
- Wei-Ming Xie
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Second Clinical School, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Clinical Research Center for Prevention Treatment and Health Care Medicine of Geriatric Diseases in Hubei Province, Wuhan, China
| | - Lu-Sen Ran
- Second Clinical School, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jie Jiang
- Second Clinical School, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu-Si Chen
- Second Clinical School, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hong-Yan Ji
- Second Clinical School, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao-Qing Quan
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Clinical Research Center for Prevention Treatment and Health Care Medicine of Geriatric Diseases in Hubei Province, Wuhan, China
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Rabanal KS, Meyer HE, Tell GS, Igland J, Pylypchuk R, Mehta S, Kumar B, Jenum AK, Selmer RM, Jackson R. Can traditional risk factors explain the higher risk of cardiovascular disease in South Asians compared to Europeans in Norway and New Zealand? Two cohort studies. BMJ Open 2017; 7:e016819. [PMID: 29217719 PMCID: PMC5728264 DOI: 10.1136/bmjopen-2017-016819] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The objective was to prospectively examine potential differences in the risk of first cardiovascular disease (CVD) events between South Asians and Europeans living in Norway and New Zealand, and to investigate whether traditional risk factors could explain any differences. METHODS We included participants (30-74 years) without prior CVD in a Norwegian (n=16 606) and a New Zealand (n=129 449) cohort. Ethnicity and cardiovascular risk factor information was linked with hospital registry data and cause of death registries to identify subsequent CVD events. We used Cox proportional hazards regression to investigate the relationship between risk factors and subsequent CVD for South Asians and Europeans, and to calculate age-adjusted HRs for CVD in South Asians versus Europeans in the two cohorts separately. We sequentially added the major CVD risk factors (blood pressure, lipids, diabetes and smoking) to study their explanatory role in observed ethnic CVD risk differences. RESULTS South Asians had higher total cholesterol (TC)/high-density lipoprotein (HDL) ratio and more diabetes at baseline than Europeans, but lower blood pressure and smoking levels. South Asians had increased age-adjusted risk of CVD compared with Europeans (87%-92% higher in the Norwegian cohort and 42%-75% higher in the New Zealand cohort) and remained with significantly increased risk after adjusting for all major CVD risk factors. Adjusted HRs for South Asians versus Europeans in the Norwegian cohort were 1.57 (95% CI 1.19 to 2.07) in men and 1.76 (95% CI 1.09 to 2.82) in women. Corresponding figures for the New Zealand cohort were 1.64 (95% CI 1.43 to 1.88) in men and 1.39 (95% CI 1.11 to 1.73) in women. CONCLUSION Differences in TC/HDL ratio and diabetes appear to explain some of the excess risk of CVD in South Asians compared with Europeans. Preventing dyslipidaemia and diabetes in South Asians may therefore help reduce their excess risk of CVD.
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Affiliation(s)
- Kjersti S Rabanal
- Division for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Haakon E Meyer
- Division for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Community Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Grethe S Tell
- Division for Health Data and Digitalisation, Norwegian Institute of Public Health, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Jannicke Igland
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Romana Pylypchuk
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Suneela Mehta
- School of Population Health, University of Auckland, Auckland, New Zealand
| | | | - Anne Karen Jenum
- Faculty of Health and Society, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Randi M Selmer
- Division for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Rod Jackson
- School of Population Health, University of Auckland, Auckland, New Zealand
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Fernando E, Razak F, Lear SA, Anand SS. Cardiovascular Disease in South Asian Migrants. Can J Cardiol 2015; 31:1139-50. [PMID: 26321436 DOI: 10.1016/j.cjca.2015.06.008] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 06/11/2015] [Accepted: 06/11/2015] [Indexed: 02/09/2023] Open
Abstract
Cardiovascular disease (CVD) represents a significant cause of global mortality and morbidity. South Asians (SAs) have a particularly high burden of coronary artery disease (CAD). This review describes current literature regarding the prevalence, incidence, etiology, and prognosis of CVD in SA migrants to high-income nations. We conducted a narrative review of CVD in the SA diaspora through a search of MEDLINE and PubMed. We included observational studies, randomized clinical trials, nonsystematic reviews, systematic reviews, and meta-analyses written in English. Of 15,231 articles identified, 827 articles were screened and 124 formed the basis for review. SA migrants have a 1.5-2 times greater prevalence of CAD than age- and sex-adjusted Europids. Increased abdominal obesity and body fat and increased burden of type 2 diabetes mellitus and dyslipidemia appear to be primary drivers of the excess CAD burden in SAs. Sedentary lifestyle and changes in diet after immigration are important contributors to weight gain and adiposity. Early life factors, physical activity patterns and, in some cases, reduced adherence to medical therapy may contribute to increased CVD risks in SAs. Novel biomarkers like leptin and adipokines may show distinct patterns in SAs and provide insights into cardiometabolic risk determinants. In conclusion, SAs have distinct CVD risk predispositions, with a complex relationship to cultural, innate, and acquired factors. Although CVD risk factor management and treatment among SAs is improving, opportunities exist for further advances.
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Affiliation(s)
- Eshan Fernando
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Fahad Razak
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada; Harvard Center for Population and Development Studies, Boston, Massachusetts, USA
| | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; Division of Cardiology, Providence Health Care, Vancouver, British Columbia, Canada
| | - Sonia S Anand
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Epidemiology, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada; Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada.
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Malik MO, Govan L, Petrie JR, Ghouri N, Leese G, Fischbacher C, Colhoun H, Philip S, Wild S, McCrimmon R, Sattar N, Lindsay RS. Ethnicity and risk of cardiovascular disease (CVD): 4.8 year follow-up of patients with type 2 diabetes living in Scotland. Diabetologia 2015; 58:716-25. [PMID: 25669630 DOI: 10.1007/s00125-015-3492-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 12/22/2014] [Indexed: 12/18/2022]
Abstract
AIMS/HYPOTHESIS Potential differences in cardiovascular risk by ethnicity remain uncertain. We evaluated the association of ethnicity with cardiovascular disease (CVD) incidence in a large cohort of people with type 2 diabetes living in Scotland. METHODS Data from Scottish Care Information-Diabetes (SCI-Diabetes) were linked to Scottish Morbidity Records (SMR01) and National Records of Scotland data for mortality for dates between 2005 and 2011. Of 156,991 people with type 2 diabetes with coded ethnicity, 121,535 (77.4%) had no CVD at baseline (White: 114,461; Multiple Ethnic: 2,554; Indian: 797; Other Asian: 319; Pakistani: 2,250; Chinese: 387; African-Caribbean: 301 and Other: 466) and were followed up (mean ± SD: 4.8 ± 2.3 years) for the development of fatal and non-fatal CVD. RESULTS During follow-up, 16,265 (13.4%) patients developed CVD (ischaemic heart or cerebrovascular diseases). At baseline, Pakistanis were younger and had developed diabetes earlier, had higher HbA1c and longer duration of diabetes, but had lower BP, BMI, creatinine, proportion of smokers and proportion on antihypertensive therapy than whites. The age and sex adjusted HRs for CVD were HR 1.31 (CI 1.17, 1.47), p < 0.001 in Pakistanis and HR 0.66 (CI 0.47, 0.92), p = 0.014 in Chinese compared with whites. Adjusting additionally for an area measure of deprivation, duration of diabetes, conventional CVD and other risk factors, the HR for Pakistanis (HR 1.45 [CI 1.14, 1.85], p = 0.002) was significantly higher, and that for Chinese (HR = 0.58 [CI 0.24, 1.40], p = 0.228) lower, compared with whites. CONCLUSIONS/INTERPRETATION Compared with whites with type 2 diabetes, those of Pakistani ethnicity in Scotland were at increased risk of CVD, whereas Chinese were at lower risk, with these differences unexplained by known risk factors.
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Affiliation(s)
- Muhammad Omar Malik
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow, Cardiovascular Research Centre, University of Glasgow, 126 University Place, G12 8TA, Glasgow, UK
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Li J, Loerbroks A, Angerer P. Physical activity and risk of cardiovascular disease: what does the new epidemiological evidence show? Curr Opin Cardiol 2014; 28:575-83. [PMID: 23928923 DOI: 10.1097/hco.0b013e328364289c] [Citation(s) in RCA: 142] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Abundant evidence has documented inverse associations of physical activity and the risk of cardiovascular disease (CVD). However, the effects of different types of physical activity (e.g., leisure time and occupational physical activity) are still poorly understood. RECENT FINDINGS Drawing on recommended and established guidelines for study selection, we identified and included 23 prospective epidemiological studies published during the last 2 years. These studies included a total of more than 790 000 adults at baseline with some 22 000 incident cases occurring during follow-up. Our findings suggest that moderate and high levels of leisure time physical activity are associated with a moderately reduced risk of CVD. In contrast, moderate and high levels of occupational physical activity showed weak positive associations, that is, a slightly increased risk of CVD. SUMMARY This updated meta-analysis supports the notion of primary prevention of CVD through engagement in leisure time physical activity. The role of occupational physical activity in CVD prevention is questionable.
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Affiliation(s)
- Jian Li
- Institute of Occupational and Social Medicine bInstitute of Medical Sociology, Center for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany.
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Gill JM, Celis-Morales CA, Ghouri N. Physical activity, ethnicity and cardio-metabolic health: Does one size fit all? Atherosclerosis 2014; 232:319-33. [DOI: 10.1016/j.atherosclerosis.2013.11.039] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 11/07/2013] [Accepted: 11/08/2013] [Indexed: 12/24/2022]
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