Gijsberts Crystel M, Seneviratna Aruni, de Carvalho Leonardo P, den Ruijter Hester M, Vidanapthirana Puwalani, Sorokin Vitaly, Stella Pieter, Agostoni Pierfrancesco, Asselbergs Folkert W, Richards A Mark, Low Adrian F, Lee Chi-Hang, Tan Huay Cheem, Hoefer Imo E, Pasterkamp Gerard, de Kleijn Dominique P V, Chan Mark Y
Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands; The Netherlands Heart Institute (ICIN), Utrecht, The Netherlands.
Cardiac Department, National University Heart Centre, National University Hospital, Singapore, Singapore.
PLoS One. 2015 Jul 6;10(7):e0132278. doi: 10.1371/journal.pone.0132278. eCollection 2015.
In 2020 the largest number of patients with coronary artery disease (CAD) will be found in Asia. Published epidemiological and clinical reports are overwhelmingly derived from western (White) cohorts and data from Asia are scant. We compared CAD severity and all-cause mortality among 4 of the world's most populous ethnicities: Whites, Chinese, Indians and Malays.
The UNIted CORoNary cohort (UNICORN) simultaneously enrolled parallel populations of consecutive patients undergoing coronary angiography or intervention for suspected CAD in the Netherlands and Singapore. Using multivariable ordinal regression, we investigated the independent association of ethnicity with CAD severity and interactions between risk factors and ethnicity on CAD severity. Also, we compared all-cause mortality among the ethnic groups using multivariable Cox regression analysis.
We included 1,759 White, 685 Chinese, 201 Indian and 224 Malay patients undergoing coronary angiography. We found distinct inter-ethnic differences in cardiovascular risk factors. Furthermore, the associations of gender and diabetes with severity of CAD were significantly stronger in Chinese than Whites. Chinese (OR 1.3 [1.1-1.7], p = 0.008) and Malay (OR 1.9 [1.4-2.6], p<0.001) ethnicity were independently associated with more severe CAD as compared to White ethnicity. Strikingly, when stratified for diabetes status, we found a significant association of all three Asian ethnic groups as compared to White ethnicity with more severe CAD among diabetics, but not in non-diabetics. Crude all-cause mortality did not differ, but when adjusted for covariates mortality was higher in Malays than the other ethnic groups.
In this population of individuals undergoing coronary angiography, ethnicity is independently associated with the severity of CAD and modifies the strength of association between certain risk factors and CAD severity. Furthermore, mortality differs among ethnic groups. Our data provide insight in inter-ethnic differences in CAD risk factors, CAD severity and mortality.
2020年，亚洲将发现数量最多的冠状动脉疾病（CAD）患者。已发表的流行病学和临床报告绝大多数来自西方（白人）队列，而亚洲的数据很少。我们比较了世界上人口最多的四个种族：白人、中国人、印度人和马来人中CAD的严重程度和全因死亡率。
联合国冠状动脉队列（UNICORN）同时纳入了在荷兰和新加坡因疑似CAD接受冠状动脉造影或干预的连续患者的平行人群。使用多变量有序回归，我们研究了种族与CAD严重程度的独立关联，以及风险因素与种族之间对CAD严重程度的相互作用。此外，我们使用多变量Cox回归分析比较了不同种族之间的全因死亡率。
我们纳入了1759名接受冠状动脉造影的白人、685名中国人、201名印度人和224名马来人患者。我们发现心血管风险因素存在明显的种族间差异。此外，中国人中性别和糖尿病与CAD严重程度的关联明显强于白人。与白人种族相比，中国人（比值比[OR]1.3[1.1 - 1.7]，p = 0.008）和马来人（OR 1.9[1.4 - 2.6]，p<0.001）种族与更严重的CAD独立相关。引人注目的是，按糖尿病状态分层时，我们发现与白人种族相比，所有三个亚洲种族在糖尿病患者中与更严重的CAD显著相关，但在非糖尿病患者中并非如此。粗全因死亡率没有差异，但在调整协变量后，马来人的死亡率高于其他种族。
在这个接受冠状动脉造影的人群中，种族与CAD的严重程度独立相关，并改变了某些风险因素与CAD严重程度之间关联的强度。此外，不同种族的死亡率不同。我们的数据提供了对CAD风险因素、CAD严重程度和死亡率种族间差异的见解。
