Basu Ansu, Sukumar Nithya, Ryder Robert Ej
Department of Diabetes, Endocrinology and Lipid Metabolism, City Hospital, Birmingham B18 7QH, UK.
The University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
JRSM Open. 2018 Jan 8;9(1):2054270417732699. doi: 10.1177/2054270417732699. eCollection 2018 Jan.
To understand the ethnic differences in coronary heart disease risk among inpatients with diabetes following acute coronary syndrome.
Single-centre retrospective cohort-analysis of patients with type II diabetes over a six-year period receiving standard care.
Birmingham, UK.
One thousand and one hundred and five patients with type II diabetes from a multi-ethnic background.
Odds ratios of coronary heart disease events among three ethnic groups.
The prevalence of coronary heart disease events was 20.7% in Asian, 13.2% in Caucasian and 7.7% in Afro-Caribbean patients. Asian patients were younger at diagnosis of diabetes (-5.1 years p < 0.001 versus Afro-Caribbeans and -7.1 years p < 0.001 versus Caucasians). The mean number of events was highest amongst Asian (1.2) compared to Caucasian (1.1) and Afro-Caribbean (1.0) patients (p = 0.04). The mean age at first event was 61.3 years for Asians, 62.5 years and 65.8 for Afro-Caribbeans and Caucasians, respectively (analysis of variance F[2,131] = 2.36 p = 0.09). Un-adjusted odds ratios for at least one coronary heart disease event were highest among Asian men (OR 5.04; 95% CI 2.31-11.01; p < 0.0001) with Afro-Caribbean women as baseline (OR 1.0). The odds ratios remain largely unchanged (1.0 Afro-Caribbeans [baseline], 1.27 [p = 0.56] Caucasians and 3.2 [p = 0.001] for Asians) when corrected for age, gender, duration of diabetes, insulin dependency, mean low-density lipoprotein-cholesterol, triglycerides and high-density lipoprotein-cholesterol, mean glycated haemoglobin, mean systolic and diastolic blood pressure (logistic regression; ROC: 79% AUC). Afro-Caribbean patients had the highest mean high-density lipoprotein-cholesterol (1.6 mmol/L) and the lowest risk for coronary heart disease events.
Asian patients were younger at their first event and diagnosed earlier with diabetes. Asian men had the highest risk of coronary heart disease event which correlated with the lowest levels of high-density lipoprotein-cholesterol.
了解急性冠脉综合征后糖尿病住院患者冠心病风险的种族差异。
对接受标准治疗的II型糖尿病患者进行为期六年的单中心回顾性队列分析。
英国伯明翰。
1105名来自多民族背景的II型糖尿病患者。
三个种族组中冠心病事件的比值比。
冠心病事件的患病率在亚洲患者中为20.7%，白种人中为13.2%，非裔加勒比人中为7.7%。亚洲患者糖尿病诊断时年龄更小（与非裔加勒比人相比小5.1岁，p<0.001；与白种人相比小7.1岁，p<0.001）。事件平均数量在亚洲患者中最高（1.2），高于白种人（1.1）和非裔加勒比人（1.0）患者（p=0.04）。首次事件的平均年龄，亚洲人为61.3岁，非裔加勒比人为62.5岁，白种人为65.8岁（方差分析F[2,131]=2.36，p=0.09）。以非裔加勒比女性为基线（比值比1.0），至少发生一次冠心病事件的未调整比值比在亚洲男性中最高（比值比5.04；95%可信区间2.31-11.01；p<0.0001）。在校正年龄、性别、糖尿病病程、胰岛素依赖、平均低密度脂蛋白胆固醇、甘油三酯和高密度脂蛋白胆固醇、平均糖化血红蛋白、平均收缩压和舒张压后（逻辑回归；ROC：曲线下面积79%），比值比基本保持不变（非裔加勒比人[基线]为1.0，白种人为1.27[p=0.56]，亚洲人为3.2[p=0.001]）。非裔加勒比患者的平均高密度脂蛋白胆固醇最高（1.6mmol/L），冠心病事件风险最低。
亚洲患者首次发病年龄更小，糖尿病诊断更早。亚洲男性冠心病事件风险最高，这与高密度脂蛋白胆固醇水平最低相关。
