Validation of the cardiovascular risk model NORRISK 2 in South Asians and people with diabetes

To evaluate the predictive ability of the previously published NORRISK 2 cardiovascular risk model in Norwegian-born and immigrants born in South Asia living in Norway, and to add information about diabetes and ethnicity in an updated model for South Asians and diabetics (NORRISK 2-SADia). Design. We included participants (30–74 years) born in Norway (n = 13,885) or South Asia (n = 1942) from health surveys conducted in Oslo 2000–2003. Cardiovascular disease (CVD) risk factor information including self-reported diabetes was linked with information on subsequent acute myocardial infarction (AMI) and acute cerebral stroke in hospital and mortality registry data throughout 2014 from the nationwide CVDNOR project. We developed an updated model using Cox regression with diabetes and South Asian ethnicity as additional predictors. We assessed model performance by Harrell’s C and calibration plots. Results. The NORRISK 2 model underestimated the risk in South Asians in all quintiles of predicted risk. The mean predicted 13-year risk by the NORRISK 2 model was 3.9% (95% CI 3.7–4.2) versus observed 7.3% (95% CI 5.9–9.1) in South Asian men and 1.1% (95% CI 1.0–1.2) versus 2.7% (95% CI 1.7–4.2) observed risk in South Asian women. The mean predictions from the NORRISK 2-SADia model were 7.2% (95% CI 6.7–7.6) in South Asian men and 2.7% (95% CI 2.4–3.0) in South Asian women. Conclusions. The NORRISK 2-SADia model improved predictions of CVD substantially in South Asians, whose risks were underestimated by the NORRISK 2 model. The NORRISK 2-SADia model may facilitate more intense preventive measures in this high-risk population.publishedVersio

Validation of the cardiovascular risk model NORRISK 2 in South Asians and people with diabetes

Objectives To evaluate the predictive ability of the previously published NORRISK 2 cardiovascular risk model in Norwegian-born and immigrants born in South Asia living in Norway, and to add information about diabetes and ethnicity in an updated model for South Asians and diabetics (NORRISK 2-SADia). Design. We included participants (30–74 years) born in Norway (n = 13,885) or South Asia (n = 1942) from health surveys conducted in Oslo 2000–2003. Cardiovascular disease (CVD) risk factor information including self-reported diabetes was linked with information on subsequent acute myocardial infarction (AMI) and acute cerebral stroke in hospital and mortality registry data throughout 2014 from the nationwide CVDNOR project. We developed an updated model using Cox regression with diabetes and South Asian ethnicity as additional predictors. We assessed model performance by Harrell’s C and calibration plots. Results. The NORRISK 2 model underestimated the risk in South Asians in all quintiles of predicted risk. The mean predicted 13-year risk by the NORRISK 2 model was 3.9% (95% CI 3.7–4.2) versus observed 7.3% (95% CI 5.9–9.1) in South Asian men and 1.1% (95% CI 1.0–1.2) versus 2.7% (95% CI 1.7–4.2) observed risk in South Asian women. The mean predictions from the NORRISK 2-SADia model were 7.2% (95% CI 6.7–7.6) in South Asian men and 2.7% (95% CI 2.4–3.0) in South Asian women. Conclusions. The NORRISK 2-SADia model improved predictions of CVD substantially in South Asians, whose risks were underestimated by the NORRISK 2 model. The NORRISK 2-SADia model may facilitate more intense preventive measures in this high-risk population.publishedVersio

Tájékoztató jelentés az őszi mezőgazdasági munkákról (2015. november 16-i operatív jelentések alapján)

A kiadvány a statisztikáról szóló 1993. évi XLVI. törvény (Stt.) 8.§ (2) bekezdése alapján készült el. Az adatszolgáltatás a Stt. felhatalmazása alapján kiadott Országos Statisztikai Adatgyűjtési Program keretein belül történt. A Nemzeti Agrárkamara (NAK) közreműködésével begyűjtött adatok a őszi mezőgazdasági munkák állásáról adnak tájékoztatást

Cardiovascular disease and ethnicity: Focus on the high risk of CVD among South Asians living in Norway and New Zealand

The burden of cardiovascular disease (CVD) among immigrants in Norway has not been described previously. Our knowledge about cardiovascular risk factors is largely based on information from European populations. Thus, the role of cardiovascular risk factors for the increased risk of CVD in South Asians is unclear. An overall aim of this thesis was to study the burden of CVD among immigrants in Norway using data from the Cardiovascular Disease in Norway (CVDNOR) project, with information from all Norwegian hospitals and the Cause of Death Registry during 1994-2009. Another aim was to study the prospective relationships between major risk factors and subsequent CVD in South Asians and Europeans, and examine to what extent these risk factors could explain any potential differences in CVD between South Asians and Europeans. Information about risk factors from Norwegian health surveys and risk factor data from the primary health care in New Zealand were linked with hospital and mortality data to study the role of cardiovascular risk factors in South Asians and Europeans. A final aim was to validate a well-known Framingham prediction model to see how well it predicted the risk of CVD in Indians versus Europeans in New Zealand. The burden of cardiovascular disease differed between immigrant groups in Norway. South Asians had more than double the risk of myocardial infarction compared to Norwegian-born, and an increased risk of stroke. Immigrants from the Former Yugoslavia also had an increased risk of CVD, while immigrants from East Asian countries had reduced risk of myocardial infarction compared to Norwegian-born. Diabetes and cholesterol partly explained the increased risk of CVD in South Asians in Norway and New Zealand. The Framingham model predicted the risk of CVD reasonably well in Indian men in New Zealand, but overestimated the risk in Indian women and in European men and women

Ethnic inequalities in acute myocardial infarction and stroke rates in Norway 1994-2009: a nationwide cohort study (CVDNOR)

Background Immigrants to Norway from South Asia and Former Yugoslavia have high levels of cardiovascular disease (CVD) risk factors. Yet, the incidence of CVD among immigrants in Norway has never been studied. Our aim was to study the burden of acute myocardial infarction (AMI) and stroke among ethnic groups in Norway. Methods We studied the whole Norwegian population (n = 2 637 057) aged 35–64 years during 1994–2009. The Cardiovascular Disease in Norway (CVDNOR) project provided information about all AMI and stroke hospital stays for this period, as well as deaths outside hospital through linkage to the Cause of Death Registry. The direct standardization method was used to estimate age standardized AMI and stroke event rates for immigrants and ethnic Norwegians. Rate ratios (RR) with ethnic Norwegians as reference were calculated using Poisson regression. Results The highest risk of AMI was seen in South Asians (men RR = 2.27; 95 % CI 2.08–2.49; women RR = 2.10; 95 % CI 1.76–2.51) while the lowest was seen in East Asians (RR = 0.38 in both men (95 % CI 0.25–0.58) and women (95 % CI 0.18–0.79)). Immigrants from Former Yugoslavia and Central Asia also had increased risk of AMI compared to ethnic Norwegians. South Asians had increased risk of stroke (men RR = 1.26; 95 % CI 1.10–1.44; women RR = 1.58; 95 % CI 1.32–1.90), as did men from Former Yugoslavia, Sub-Saharan Africa and women from Southeast Asia. Conclusions Preventive measures should be aimed at reducing the excess numbers of CVD among immigrants from South Asia and Former Yugoslavia

Mange flyktninger har høy risiko for hjerte og karsykdom

Risikoen for hjerte- og karsykdom varierer betydelig i ulike deler av verden, også innenfor Europa. Norske leger må huske på dette når de har pasienter fra andre land, for eksempel flyktninger fra Ukraina. Dødeligheten av hjerte- og karsykdommer er mer enn fem ganger høyere i Ukraina sammenlignet med Norge (figur 1) (1). Dette bør tas med i vurderingen av forebyggende behandling hos pasienter med ukrainsk bakgrunn. En praktisk tilnærming kan være å justere opp risikoestimatene fra NORRISK2 (2) til et nivå som tilsvarer de europeiske risikoestimatene som anbefales brukt i områder med ekstra høy risiko (3).publishedVersio

Performance of a Framingham cardiovascular risk model among Indians and Europeans in New Zealand and the role of body mass index and social deprivation

Objectives To evaluate a Framingham 5-year cardiovascular disease (CVD) risk score in Indians and Europeans in New Zealand, and determine whether body mass index (BMI) and socioeconomic deprivation were independent predictors of CVD risk. Methods We included Indians and Europeans, aged 30–74 years without prior CVD undergoing risk assessment in New Zealand primary care during 2002–2015 (n=256 446). Risk profiles included standard Framingham predictors (age, sex, systolic blood pressure, total cholesterol/high-density lipoprotein ratio, smoking and diabetes) and were linked with national CVD hospitalisations and mortality datasets. Discrimination was measured by the area under the receiver operating characteristics curve (AUC) and calibration examined graphically. We used Cox regression to study the impact of BMI and deprivation on the risk of CVD with and without adjustment for the Framingham score. Results During follow-up, 8105 and 1156 CVD events occurred in Europeans and Indians, respectively. Higher AUCs of 0.76 were found in Indian men (95% CI 0.74 to 0.78) and women (95% CI 0.73 to 0.78) compared with 0.74 (95% CI 0.73 to 0.74) in European men and 0.72 (95% CI 0.71 to 0.73) in European women. Framingham was best calibrated in Indian men, and overestimated risk in Indian women and in Europeans. BMI and deprivation were positively associated with CVD, also after adjustment for the Framingham risk score, although the BMI association was attenuated. Conclusions The Framingham risk model performed reasonably well in Indian men, but overestimated risk in Indian women and in Europeans. BMI and socioeconomic deprivation could be useful predictors in addition to a Framingham score

Validation of the cardiovascular risk model NORRISK 2 in South Asians and people with diabetes

Objectives To evaluate the predictive ability of the previously published NORRISK 2 cardiovascular risk model in Norwegian-born and immigrants born in South Asia living in Norway, and to add information about diabetes and ethnicity in an updated model for South Asians and diabetics (NORRISK 2-SADia). Design. We included participants (30–74 years) born in Norway (n = 13,885) or South Asia (n = 1942) from health surveys conducted in Oslo 2000–2003. Cardiovascular disease (CVD) risk factor information including self-reported diabetes was linked with information on subsequent acute myocardial infarction (AMI) and acute cerebral stroke in hospital and mortality registry data throughout 2014 from the nationwide CVDNOR project. We developed an updated model using Cox regression with diabetes and South Asian ethnicity as additional predictors. We assessed model performance by Harrell’s C and calibration plots. Results. The NORRISK 2 model underestimated the risk in South Asians in all quintiles of predicted risk. The mean predicted 13-year risk by the NORRISK 2 model was 3.9% (95% CI 3.7–4.2) versus observed 7.3% (95% CI 5.9–9.1) in South Asian men and 1.1% (95% CI 1.0–1.2) versus 2.7% (95% CI 1.7–4.2) observed risk in South Asian women. The mean predictions from the NORRISK 2-SADia model were 7.2% (95% CI 6.7–7.6) in South Asian men and 2.7% (95% CI 2.4–3.0) in South Asian women. Conclusions. The NORRISK 2-SADia model improved predictions of CVD substantially in South Asians, whose risks were underestimated by the NORRISK 2 model. The NORRISK 2-SADia model may facilitate more intense preventive measures in this high-risk population