PT  - JOURNAL ARTICLE
AU  - Kjersti S Rabanal
AU  - Haakon E Meyer
AU  - Grethe S Tell
AU  - Jannicke Igland
AU  - Romana Pylypchuk
AU  - Suneela Mehta
AU  - Bernadette Kumar
AU  - Anne Karen Jenum
AU  - Randi M Selmer
AU  - Rod Jackson
TI  - Can traditional risk factors explain the higher risk of cardiovascular disease in South Asians compared to Europeans in Norway and New Zealand? Two cohort studies
AID  - 10.1136/bmjopen-2017-016819
DP  - 2017 Dec 01
TA  - BMJ Open
PG  - e016819
VI  - 7
IP  - 12
4099  - http://bmjopen.bmj.com/content/7/12/e016819.short
4100  - http://bmjopen.bmj.com/content/7/12/e016819.full
SO  - BMJ Open2017 Dec 01; 7
AB  - Objectives The objective was to prospectively examine potential differences in the risk of first cardiovascular disease (CVD) events between South Asians and Europeans living in Norway and New Zealand, and to investigate whether traditional risk factors could explain any differences.Methods We included participants (30–74 years) without prior CVD in a Norwegian (n=16 606) and a New Zealand (n=129 449) cohort. Ethnicity and cardiovascular risk factor information was linked with hospital registry data and cause of death registries to identify subsequent CVD events. We used Cox proportional hazards regression to investigate the relationship between risk factors and subsequent CVD for South Asians and Europeans, and to calculate age-adjusted HRs for CVD in South Asians versus Europeans in the two cohorts separately. We sequentially added the major CVD risk factors (blood pressure, lipids, diabetes and smoking) to study their explanatory role in observed ethnic CVD risk differences.Results South Asians had higher total cholesterol (TC)/high-density lipoprotein (HDL) ratio and more diabetes at baseline than Europeans, but lower blood pressure and smoking levels. South Asians had increased age-adjusted risk of CVD compared with Europeans (87%–92% higher in the Norwegian cohort and 42%–75% higher in the New Zealand cohort) and remained with significantly increased risk after adjusting for all major CVD risk factors. Adjusted HRs for South Asians versus Europeans in the Norwegian cohort were 1.57 (95% CI 1.19 to 2.07) in men and 1.76 (95% CI 1.09 to 2.82) in women. Corresponding figures for the New Zealand cohort were 1.64 (95% CI 1.43 to 1.88) in men and 1.39 (95% CI 1.11 to 1.73) in women.Conclusion Differences in TC/HDL ratio and diabetes appear to explain some of the excess risk of CVD in South Asians compared with Europeans. Preventing dyslipidaemia and diabetes in South Asians may therefore help reduce their excess risk of CVD.