Ethnicity and risk of cardiovascular disease (CVD): 4.8 year follow-up of patients with type 2 diabetes living in Scotland

Muhammad Omar Malik, L Govan, John R Petrie, Nazim Ghouri, Graham Leese, Colin Fischbacher, Helen Colhoun, Sam Philip, Sarah Wild, Rory McCrimmon, Naveed Sattar, Robert S Lindsay, Scottish Diabetes Research Network (SDRN) Epidemiology group

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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.

Original languageEnglish
Pages (from-to)716-725
Number of pages10
JournalDiabetologia
Volume58
Issue number4
Early online date12 Feb 2015
DOIs
Publication statusPublished - Apr 2015

Keywords

  • cardiovascular disease (CVD)
  • Cox-regression
  • ethnicity
  • HbA1c
  • longitudinal
  • Pakistani
  • renal failure
  • type 2 diabetes
  • white

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    Malik, M. O., Govan, L., Petrie, J. R., Ghouri, N., Leese, G., Fischbacher, C., Colhoun, H., Philip, S., Wild, S., McCrimmon, R., Sattar, N., Lindsay, R. S., & Scottish Diabetes Research Network (SDRN) Epidemiology group (2015). Ethnicity and risk of cardiovascular disease (CVD): 4.8 year follow-up of patients with type 2 diabetes living in Scotland. Diabetologia, 58(4), 716-725. https://doi.org/10.1007/s00125-015-3492-0