George Julie, Mathur Rohini, Shah Anoop Dinesh, Pujades-Rodriguez Mar, Denaxas Spiros, Smeeth Liam, Timmis Adam, Hemingway Harry
The Farr Institute of Health Informatics Research and the National Institute for Health Research, Biomedical Research Centre, University College London, London, United Kingdom.
Electronic Health Records Group, Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
PLoS One. 2017 Jun 9;12(6):e0178945. doi: 10.1371/journal.pone.0178945. eCollection 2017.
While the association of ethnic group with individual cardiovascular diseases has been studied, little is known about ethnic differences in the initial lifetime presentation of clinical cardiovascular disease in contemporary populations.
We studied 1,068,318 people, aged ≥30 years and free from diagnosed CVD at baseline (90.9% White, 3.6% South Asian and 2.9% Black), using English linked electronic health records covering primary care, hospital admissions, acute coronary syndrome registry and mortality registry (CALIBER platform). During 5.7 years median follow-up between 1997-2010, 95,224 people experienced an incident cardiovascular diagnosis. 69.9% (67.2%-72.4%) of initial presentation in South Asian <60 yrs were coronary heart disease presentations compared to 47.8% (47.3%-48.3%) in White and 40.1% (36.3%-43.9%) in Black patients. Compared to White patients, Black patients had significantly lower age-sex adjusted hazard ratios (HRs) for initial lifetime presentation of all the coronary disease diagnoses (stable angina HR 0.80 (95% CI 0.68-0.93); unstable angina- 0.75 (0.59-0.97); myocardial infarction 0.49 (0.40-0.62)) while South Asian patients had significantly higher HRs (stable angina- 1.67 (1.52-1.84); unstable angina 1.82 (1.56-2.13); myocardial infarction- 1.67 (1.49-1.87). We found no ethnic differences in initial presentation with heart failure (Black 0.97 (0.79-1.20); S Asian 1.04(0.87-1.26)). Compared to White patients, Black patients were more likely to present with ischaemic stroke (1.24 (0.97-1.58)) and intracerebral haemorrhage (1.44 (0.97-2.12)). Presentation with peripheral arterial disease was less likely for Black (0.63 (0.50-0.80)) and South Asian patients (0.70 (0.57-0.86)) compared with White patients.
While we found the anticipated substantial predominance of coronary heart disease presentations in South Asian and predominance of stroke presentations in Black patients, we found no ethnic differences in presentation with heart failure. We consider the public health and research implications of our findings.
NCT02176174, www.clinicaltrials.gov.
虽然已经对种族与个体心血管疾病之间的关联进行了研究，但对于当代人群临床心血管疾病首次发病时的种族差异却知之甚少。
我们使用涵盖初级保健、住院、急性冠状动脉综合征登记和死亡率登记（CALIBER平台）的英文关联电子健康记录，对1,068,318名年龄≥30岁且基线时未诊断出患有心血管疾病的人群进行了研究（90.9%为白人，3.6%为南亚人，2.9%为黑人）。在1997年至2010年的5.7年中位随访期间，有95,224人经历了心血管疾病的初次诊断。南亚人<60岁时初次发病的69.9%（67.2%-72.4%）为冠心病发病，而白人中这一比例为47.8%（47.3%-48.3%），黑人患者中为40.1%（36.3%-43.9%）。与白人患者相比，黑人患者在所有冠心病诊断初次发病时的年龄性别调整风险比（HRs）显著更低（稳定型心绞痛HR为0.80（95%CI 0.68-0.93）；不稳定型心绞痛为0.75（0.59-0.97）；心肌梗死为0.49（0.40-0.62）），而南亚患者的HRs显著更高（稳定型心绞痛为1.67（1.52-1.84）；不稳定型心绞痛为1.82（1.56-2.13）；心肌梗死为1.67（1.49-1.87））。我们发现心力衰竭初次发病时不存在种族差异（黑人0.97（0.79-1.20）；南亚人1.04（0.87-1.26））。与白人患者相比，黑人患者更易出现缺血性中风（1.24（0.97-1.58））和脑出血（1.44（0.97-2.12））。与白人患者相比，黑人（0.63（0.50-0.80））和南亚患者（0.70（0.57-0.86））出现外周动脉疾病的可能性较小。
虽然我们发现南亚人冠心病发病占主导以及黑人患者中风发病占主导在意料之中，但我们发现心力衰竭发病不存在种族差异。我们考虑了我们研究结果对公共卫生和研究的影响。
NCT02176174，www.clinicaltrials.gov。
