Article Text

Original research
Cardiovascular disease recurrence and long-term mortality in a tri-ethnic British cohort
  1. Manav Vyas1,
  2. Nish Chaturvedi2,
  3. Alun D Hughes2,
  4. Michael Marmot3,
  5. Therese Tillin2
  1. 1Division of Neurology, University of Toronto, Toronto, Ontario, Canada
  2. 2MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
  3. 3Epidemiology and Public Health, University College London, London, UK
  1. Correspondence to Dr Therese Tillin, MRC Unit for Lifelong Health and Ageing at UCL, University College London, London WC1E 6BT, UK; t.tillin{at}ucl.ac.uk

Abstract

Objective Ethnic differences in cardiovascular disease incidence, but not cardiovascular disease recurrence, are reported. We characterised long-term risk of major adverse cardiovascular event (MACE) and mortality following a non-fatal cardiovascular event in a British cohort of South Asians, African Caribbeans and Europeans.

Methods We identified index and recurrent cardiovascular events and mortality between 1988 and 2017 using hospital records and death registry. Using multivariable hazards models, we separately calculated the adjusted HR of MACE and death following index event, adjusting for demographics, vascular and lifestyle risk factors. Using interaction terms, we evaluated if decade of index event modified the association between ethnicity and outcomes.

Results South Asians were younger at the index event (median age 66 years, n=396) than Europeans (69 years, n=335) and African Caribbeans (70 years, n=70). During 4228 person-years, of the 801 patients, 537 developed MACE and 338 died, with the highest crude rate of MACE in South Asians. On adjustment of baseline factors, compared with the Europeans, the higher risk of MACE (HR 0.97, 95% CI 0.77 to 1.21) and the lower risk of mortality (HR 0.95, 95% CI 0.72 to 1.26) in South Asians was eliminated. African Caribbeans had similar outcomes to Europeans (HR MACE 1.04, 95% CI 0.74 to 1.47; and HR death 1.07, 95% CI 0.70 to 1.64). Long-term survival following an index event improved in South Asians (ptrend 0.02) and African Caribbeans (ptrend 0.07) compared with Europeans.

Conclusions Baseline vascular risk factors explained the observed ethnic variation in cardiovascular disease recurrence and long-term mortality, with a relative improvement in survival of minority ethnic groups over time.

  • epidemiology
  • quality and outcomes of care
  • cardiac risk factors and prevention
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Footnotes

  • Contributors MVV was responsible for study conception, design of the study, data analysis and interpretation of results. NC was responsible for study conception, design of the study and interpretation of results. AH and MM were responsible for interpretation of results. TT was responsible for study conception, design of the study, analysis and interpretation of results and supervision of the project. MVV wrote the manuscript that was critically assessed by all others.

  • Funding The study was funded at baseline by the UK Medical Research Council and Diabetes UK. Follow-up studies have been funded by the Wellcome Trust, British Heart Foundation and Diabetes UK. ADH and NC received support from the National Institute for Health Research University College London Hospitals Biomedical Research Centre. ADH and NC work in a unit that receives support from the UK Medical Research Council (MC_UU_12019/1). Support has also been provided at follow-up by the North and West London and Central and East London National Institute of Health Research Clinical Research Networks.

  • Competing interests NC receives funds from AstraZeneca for work on a trial data safety and monitoring committee. MVV holds a Fellowship Award from the Canadian Institutes of Health Research and the Prince Mahidol Marmot Fellowship Award.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by St Mary’s Hospital Research Ethic Committee (07/H0712/109) and by Fulham Research Ethics Committee (14/LO/0108) and cohort participants were not involved in the dissemination plans for this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. Please contact the corresponding author for data.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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