Patel J V, Lim H S, Gunarathne A, Tracey I, Durrington P N, Hughes E A, Lip G Y H
Sandwell General Hospital, West Bromwich, B71 4HJ, UK.
QJM. 2008 Mar;101(3):231-6. doi: 10.1093/qjmed/hcm151. Epub 2008 Jan 19.
It has been reported that hypertension carries a greater risk of myocardial infarction (MI) in South Asians living in the UK than in the indigenous British population. This has been attributed to some specifically Asian susceptibility factor.
Using a longitudinal approach, we investigated the relationship between coronary heart disease (CHD) risk factors amongst hypertension patients attending Sandwell and City Hospitals, and the onset of cardiovascular events over a 5-year follow-up period.
A total of 350 Caucasian (83.7% male) and 104 South Asian (66.3% male) patients with hypertension [age 63.7 (7.6) years and 57.1 (11.1) years respectively, P < 0.001] were followed-up for a mean (SD) period of 64.7(12.1) months. There were 11 (6.4/1000 patient years) cases of MI in Caucasian patients vs. 11 (17.8/1000 patient years) in South Asians, with event-free survival times being significantly lower amongst South Asians (log-rank test P = 0.04). The prevalence of diabetes mellitus was 22.9% higher amongst South Asians (P < 0.001), whilst mean serum cholesterol and fasting triglyceride levels were higher amongst Caucasians (P = 0.001). There were no ethnic differences in HDL cholesterol concentrations, the use of tobacco, statin therapy or anti-platelet therapies (all P = NS), or in composite endpoint (MI, angina, peripheral vascular disease, stroke, revascularization or death; P = 0.74). On Cox regression analysis of all independent cardiovascular risk variables, associated treatments and ethnicity, MI risk was associated with diabetes mellitus (odds ratio 3.77, 95%CI 1.55-9.15, P = 0.003) but not ethnicity per se (P = 0.26).
Increased risk of MI in hypertensive South Asians in the United Kingdom appears to be the result of a higher prevalence of diabetes mellitus. Further work is required to understand the pathophysiological basis with which diabetes increases CHD risk in this ethnic group.
据报道，在英国生活的南亚人中，高血压患者发生心肌梗死（MI）的风险高于英国本土人群。这归因于一些特定的亚洲易感性因素。
采用纵向研究方法，我们调查了桑德韦尔和城市医院的高血压患者中冠心病（CHD）危险因素与5年随访期内心血管事件发生之间的关系。
共有350名白种人（83.7%为男性）和104名南亚人（66.3%为男性）高血压患者[年龄分别为63.7（7.6）岁和57.1（11.1）岁，P<0.001]，平均（标准差）随访64.7（12.1）个月。白种人患者中有11例（6.4/1000患者年）发生MI，而南亚人中有11例（17.8/1000患者年），南亚人的无事件生存时间显著更低（对数秩检验P=0.04）。南亚人糖尿病患病率高22.9%（P<0.001），而白种人的平均血清胆固醇和空腹甘油三酯水平更高（P=0.001）。高密度脂蛋白胆固醇浓度、吸烟情况、他汀类药物治疗或抗血小板治疗（所有P=无显著性差异）以及复合终点（MI、心绞痛、外周血管疾病、中风、血运重建或死亡；P=0.74）方面无种族差异。对所有独立的心血管危险因素、相关治疗和种族进行Cox回归分析，MI风险与糖尿病相关（比值比3.77，95%置信区间1.55 - 9.15，P=0.003），但与种族本身无关（P=0.26）。
英国高血压南亚人MI风险增加似乎是糖尿病患病率较高的结果。需要进一步开展工作以了解糖尿病增加该种族冠心病风险的病理生理基础。
