Diabetes Centre, Heart of England NHS Foundation Trust, Birmingham, UK.
Curr Med Res Opin. 2010 Aug;26(8):1873-9. doi: 10.1185/03007995.2010.490468.
BACKGROUND/AIM: People of south Asian origin have an excessive risk of morbidity and mortality from cardiovascular disease. We examined the effect of ethnicity on known risk factors and analysed the risk of cardiovascular events and mortality in UK south Asian and white Europeans patients with type 2 diabetes over a 2 year period.
A total of 1486 south Asian (SA) and 492 white European (WE) subjects with type 2 diabetes were recruited from 25 general practices in Coventry and Birmingham, UK. Baseline data included clinical history, anthropometry and measurements of traditional risk factors - blood pressure, total cholesterol, HbA1c. Multiple linear regression models were used to examine ethnicity differences in individual risk factors. Ten-year cardiovascular risk was estimated using the Framingham and UKPDS equations. All subjects were followed up for 2 years. Cardiovascular events (CVD) and mortality between the two groups were compared.
ISRCTN 38297969.
Significant differences were noted in risk profiles between both groups. After adjustment for clustering and confounding a significant ethnicity effect remained only for higher HbA1c (0.50 [0.22 to 0.77]; P = 0.0004) and lower HDL (-0.09 [-0.17 to -0.01]; P = 0.0266). Baseline CVD history was predictive of CVD events during follow-up for SA (P < 0.0001) but not WE (P = 0.189). Mean age at death was 66.8 (11.8) for SA vs. 74.2 (12.1) for WE, a difference of 7.4 years (95% CI 1.0 to 13.7 years), P = 0.023. The adjusted odds ratio of CVD event or death from CVD was greater but not significantly so in SA than in WE (OR 1.4 [0.9 to 2.2]).
Fewer events in both groups and short period of follow-up are key limitations. Longer follow-up is required to see if the observed differences between the ethnic groups persist.
South Asian patients with type 2 diabetes in the UK have a higher cardiovascular risk and present with cardiovascular events at a significantly younger age than white Europeans. Enhanced and ethnicity specific targets and effective treatments are needed if these inequalities are to be reduced.
背景/目的：南亚裔人群患心血管疾病的发病率和死亡率过高。我们研究了种族对已知危险因素的影响，并分析了英国南亚裔和白种欧洲裔 2 型糖尿病患者在两年内发生心血管事件和死亡的风险。
从英国考文垂和伯明翰的 25 家普通诊所招募了 1486 名南亚裔（SA）和 492 名白种欧洲裔（WE）2 型糖尿病患者。基线数据包括临床病史、人体测量学和传统危险因素的测量值——血压、总胆固醇、HbA1c。采用多元线性回归模型分析两组间个体危险因素的种族差异。使用Framingham 和 UKPDS 方程估计 10 年心血管风险。所有患者随访 2 年。比较两组之间的心血管事件（CVD）和死亡率。
ISRCTN38297969。
两组之间的风险特征存在显著差异。在调整聚类和混杂因素后，仅 HbA1c 较高（0.50 [0.22 至 0.77]；P=0.0004）和 HDL 较低（-0.09 [-0.17 至 -0.01]；P=0.0266）存在显著的种族效应。基线 CVD 病史是 SA 患者随访期间 CVD 事件的预测因素（P<0.0001），但对 WE 患者（P=0.189）不是。SA 患者的平均死亡年龄为 66.8（11.8）岁，而 WE 患者为 74.2（12.1）岁，差异为 7.4 岁（95%CI 1.0 至 13.7 岁），P=0.023。SA 患者发生 CVD 事件或 CVD 死亡的调整比值比（OR）高于但不显著高于 WE 患者（OR 1.4 [0.9 至 2.2]）。
两组的事件都较少且随访时间较短是主要限制。需要更长时间的随访，以观察两组之间的差异是否持续存在。
英国的南亚裔 2 型糖尿病患者心血管风险更高，发生心血管事件的年龄明显低于白种欧洲裔患者。如果要减少这些不平等现象，就需要制定更具针对性和更有效的治疗方法。
