Ethnicity and prediction of cardiovascular disease: performance of QRISK2 and Framingham scores in a U.K. tri-ethnic prospective cohort study (SABRE--Southall And Brent REvisited).

OBJECTIVE: To evaluate QRISK2 and Framingham cardiovascular disease (CVD) risk scores in a tri-ethnic U.K. population. DESIGN: Cohort study. SETTING: West London. PARTICIPANTS: Randomly selected from primary care lists. Follow-up data were available for 87% of traced participants, comprising 1866 white Europeans, 1377 South Asians, and 578 African Caribbeans, aged 40-69 years at baseline (1998-1991). MAIN OUTCOME MEASURES: First CVD events: myocardial infarction, coronary revascularisation, angina, transient ischaemic attack or stroke reported by participant, primary care or hospital records or death certificate. RESULTS: During follow-up, 387 CVD events occurred in men (14%) and 78 in women (8%). Both scores underestimated risk in European and South Asian women (ratio of predicted to observed risk: European women: QRISK2: 0.73, Framingham: 0.73; South Asian women: QRISK2: 0.52, Framingham: 0.43). In African Caribbeans, Framingham over-predicted in men and women and QRISK2 over-predicted in women. Framingham classified 28% of participants as high risk, predicting 54% of all such events. QRISK2 classified 19% as high risk, predicting 42% of all such events. Both scores performed poorly in identifying high risk African Caribbeans; QRISK2 and Framingham identified as high risk only 10% and 24% of those who experienced events. CONCLUSIONS: Neither score performed consistently well in all ethnic groups. Further validation of QRISK2 in other multi-ethnic datasets, and better methods for identifying high risk African Caribbeans and South Asian women, are required

Relation of triglyceride stores in skeletal muscle cells to central obesity and insulin sensitivity in European and South Asian men

AIMS/HYPOTHESIS: To compare the relation between intramyocellular lipid content, central obesity and insulin sensitivity in Europeans and South Asians. METHODS: Cross-sectional study of 40 South Asian and European non-diabetic men matched for age and body mass index. We measured intramyocellular lipid by proton magnetic resonance spectroscopy of soleus muscle, insulin sensitivity by the short insulin tolerance test, per cent body fat by dual-energy x-ray absorptiometry and visceral fat by single-slice computed tomography of the abdomen. RESULTS: South Asians compared with Europeans had a higher mean per cent body fat (26.8% vs 22.5%, p = 0.05) and lower insulin sensitivity (mean +/- SEM 2.4 +/- 0.2 vs 3.4%/min +/- 0.3, p = 0.013). Mean (+/- SEM) intramyocellular lipid content was higher in South Asians than in Europeans (72.1 +/- 7.5 vs 53.6 +/- 4.9 mmol/kg dry weight, p = 0.046). In Europeans intramyocellular lipid was correlated with per cent body fat (r = 0.50, p = 0.028), waist:hip ratio (r = 0.74, p < 0.001), visceral fat (r = 0.62, p = 0.004) and insulin sensitivity (r = -0.53, p = 0.016). In South Asians intramyocellular lipid was not significantly related to insulin sensitivity or obesity, and the strongest associations of insulin sensitivity were with fasting plasma triglyceride and waist:hip ratio. CONCLUSION/INTERPRETATION: The association of intramyocellular lipid with insulin sensitivity and obesity in Europeans is consistent with the hypothesis that muscle triglyceride mediates the effect of obesity on insulin sensitivity. The absence of a similar relation of insulin sensitivity to intramyocellular lipid in South Asians suggests that other mechanisms underlie the high insulin resistance observed in this group

Health of a Punjabi ethnic minority in Glasgow: a comparison with the general population.

OBJECTIVE--To compare common health experiences of a South Asian (predominantly Punjabi) population with that of the general population, according to sex, and to related patterns of health in the fourth decade of life to the pattern of hospital admission and mortality documented in the published reports. DESIGN AND SETTING--A cross sectional survey with interviews and physical measures was undertaken in a two stage stratified random cluster sample in the city of Glasgow. SAMPLE--This comprised 159 South Asians aged 30-40 years, mean age 35 (73.6% of those invited) and 319 subjects from the general population, all aged 35 years. MEASUREMENTS AND MAIN RESULTS--Body structure, lung function, pulse and blood pressure, history of physical and mental health, results of standardised questionnaires on mental health, angina and respiratory health, recent and past symptoms, history of accidents, and sickness behaviour were determined. South Asians were shorter, broader, and more overweight (women); they had lower values for forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC), a faster pulse, and higher diastolic pressure (men). Fewer South Asians had had accidents or digestive symptoms (men); more had psychosomatic and high total symptoms (women); fewer wore glasses, had lost teeth, or had long standing illness (men) (all p < 0.01). Women had a lower FEV1/FVC ratio (p < 0.05). CONCLUSIONS--South Asians were consistently disadvantaged only in terms of anthropometric measures. Otherwise, the many differences were balanced, with disadvantage being concentrated only among South Asian women. The health gap between sexes in South Asians seems higher than in the general population. The findings show patterns of health in the fourth decade of life which are consistent with patterns of hospital admission and mortality documented in the published reports

Homocysteine, folate, vitamin B12, and cardiovascular risk in Indians, Malays, and Chinese in Singapore

OBJECTIVE—To examine the hypothesis that the higher rates of coronary heart disease (CHD) in Indians (South Asians) compared with Malays and Chinese is partly attributable to differences in blood concentrations of homocysteine, and related blood concentrations of folate and vitamin B12.
DESIGN—Cross sectional study of the general population.
SETTING—Singapore.
PARTICIPANTS—Random sample of 726 fasting subjects aged 30 to 69( )years.
MAIN RESULTS—Mean plasma total homocysteine concentrations did not show significant ethnic differences; values were Indians (men 16.2 and women 11.5 µmol/l), Malays (men 15.0 and women 12.5 µmol/l), and Chinese (men 15.3 and women 12.2 µmol/l). Similarly, the proportions with high plasma homocysteine (>14.0 µmol/l) showed no important ethnic differences being, Indians (men 60.0 and women 21.9 %), Malays (men 53.9 and women 37.8 %), and Chinese (men 56.6 and women 30.6 %). Mean plasma folate concentrations were lower in Indians (men 8.7 and women 10.9 nmol/l) and Malays (men 8.5 and women 10.8 nmol/l), than Chinese (men 9.7 and women 13.8 nmol/l). Similarly, the proportions with low plasma folate (<6.8 nmol/l) were higher in Indians (men 44.9 and women 36.6 %) and Malays (men 45.3 and women 24.5 %) than Chinese (men 31.4 and women 12.6( )%). Mean plasma vitamin B12 concentrations were lowest in Indians (men 352.5 and women 350.7 pmol/l), then Chinese (men 371.1 and women 373.7 pmol/l), and then Malays (men 430.5 and women 486.0( )pmol/l).
CONCLUSION—While there were ethnic differences for plasma folate and vitamin B12 (in particular lower levels in Indians), there was no evidence that homocysteine plays any part in the differential ethnic risk from CHD in Singapore and in particular the increased susceptibility of Indians to the disease.


Keywords: coronary heart disease; ethnic; homocystein