Northwestern University School of Medicine, Chicago, IL, USA.
Am Heart J. 2011 Apr;161(4):755-63. doi: 10.1016/j.ahj.2010.12.013.
We aimed to test the impact of race/ethnicity on coronary artery disease (CAD) after adjusting for baseline risk factors.
Whether race/ethnicity remains an important determinant of the burden of CAD even among patients with long-standing type 2 diabetes (diabetes mellitus) and established CAD is unknown.
Analysis of baseline data from the BARI 2D trial (January 1, 2001, to March 31, 2005) was performed. Myocardial jeopardy index (MJI) was evaluated by a blinded core angiographic laboratory. Multivariate regression analysis was performed to determine the independent association of race/ethnicity on the burden of CAD after adjusting for baseline risk factors. Data were collected from US and Canadian academic and community hospitals. The baseline analysis was performed on patients with long-standing diabetes and documented CAD with no prior revascularization at study entry (n = 1,331). The main outcome measure was MJI, which represents the percentage of myocardium jeopardized by significant lesions (≥50%). The secondary outcome measure was ≥2 lesions with ≥50% stenosis.
Risk factors varied significantly among racial/ethnic groups. Blacks were significantly more likely to be women, have no health insurance, be current smokers, have higher body mass index, have hypertension, have a longer duration of diabetes, a higher hemoglobin A(1c) level, and were more likely to be taking insulin. Their mean total, low-density lipid, and high-density lipid cholesterol levels were higher, whereas their triglycerides were lower than others. After controlling for baseline risk factors, blacks had a significantly lower burden of CAD; the adjusted MJI was 5.43 U lower (95% CI -9.13 to -1.72), and the adjusted number of lesions was 0.53 fewer (95% CI -0.88 to -0.18) in blacks compared to whites.
In the BARI 2D trial, self-reported race/ethnicity is associated with important differences in baseline risk factors and is a powerful predictor of the burden of CAD adjusting for such baseline differences. These findings may help direct medical intervention and resources and further investigation into the basis of racial/ethnic differences in CAD burden.
本研究旨在调整基线风险因素后，检验种族/民族对冠状动脉疾病（CAD）的影响。
种族/民族是否仍然是长期 2 型糖尿病（糖尿病）和已确诊 CAD 患者 CAD 负担的重要决定因素尚不清楚。
对 BARI 2D 试验的基线数据（2001 年 1 月 1 日至 2005 年 3 月 31 日）进行分析。心肌危险指数（MJI）由盲法核心血管造影实验室评估。多变量回归分析用于确定在调整基线风险因素后，种族/民族与 CAD 负担之间的独立关联。数据来自美国和加拿大的学术和社区医院。基线分析纳入了长期糖尿病且研究入组时无既往血运重建的有记录 CAD 患者（n=1331）。主要观察指标为 MJI，代表有显著病变（≥50%）的心肌受损百分比。次要观察指标为≥2 个狭窄≥50%的病变。
不同种族/民族的危险因素存在显著差异。黑人患者更可能为女性、无医疗保险、当前吸烟者、体重指数更高、患有高血压、糖尿病病程更长、糖化血红蛋白水平更高，且更可能使用胰岛素。他们的总胆固醇、低密度脂蛋白胆固醇和高密度脂蛋白胆固醇水平更高，而甘油三酯水平更低。在控制基线风险因素后，黑人的 CAD 负担显著降低；调整后的 MJI 低 9.13-1.72 个单位（95%CI），调整后的病变数少 0.53 个（95%CI-0.88 至-0.18）。
在 BARI 2D 试验中，自我报告的种族/民族与基线风险因素存在显著差异，并且是调整此类基线差异后 CAD 负担的有力预测因素。这些发现可能有助于指导医疗干预和资源，并进一步研究 CAD 负担种族/民族差异的基础。
