Racial and Ethnic Differences in the Association Between Classical Cardiovascular Risk Factors and Common Carotid Intima-Media Thickness: An Individual Participant Data Meta-Analysis

Engelbert A. Nonterah*, Nigel J. Crowther, for the H3Africa AWI-Gen, USE-IMT collaborative study group, Kerstin Klipstein-Grobusch, Abraham R. Oduro, Maryam Kavousi, Godfred Agongo, Todd J. Anderson, Gershim Asiki, Palwendé R. Boua, Solomon S.R. Choma, David J. Couper, Gunnar Engström, Jacqueline de Graaf, Jussi Kauhanen, Eva M. Lonn, Ellisiv B. Mathiesen, Lisa K. Micklesfield, Shuhei Okazaki, Joseph F. PolakTatjana Rundek, Jukka T. Salonen, Stephen M. Tollman, Tomi Pekka Tuomainen, Diederick E. Grobbee, Michéle Ramsay, Michiel L. Bots

*Corresponding author for this work

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BACKGROUND: The major risk factors for atherosclerotic cardiovascular disease differ by race or ethnicity but have largely been defined using populations of European ancestry. Despite the rising prevalence of cardiovascular disease in Africa there are few related data from African populations. Therefore, we compared the association of established cardiovascular risk factors with carotid-intima media thickness (CIMT), a subclinical marker of atherosclerosis, between African, African American, Asian, European, and Hispanic populations. METHODS AND RESULTS: Cross-sectional analyses of 34 025 men and women drawn from 15 cohorts in Africa, Asia, Europe, and North America were undertaken. Classical cardiovascular risk factors were assessed and CIMT measured using B-mode ultrasound. Ethnic differences in the association of established cardiovascular risk factors with CIMT were determined using a 2-stage individual participant data meta-analysis with beta coefficients expressed as a percentage using the White population as the reference group. CIMT adjusted for risk factors was the greatest among African American populations followed by Asian, European, and Hispanic populations with African populations having the lowest mean CIMT. In all racial or ethnic groups, men had higher CIMT levels compared with women. Age, sex, body mass index, and systolic blood pressure had a significant positive association with CIMT in all races and ethnicities at varying magnitudes. When compared with European populations, the association of age, sex, and systolic blood pressure with CIMT was weaker in all races and ethnicities. Smoking (beta coeffi-cient, 0.39; 95% CI, 0.09– 0.70), body mass index (beta coefficient, 0.05; 95% CI, 0.01– 0.08) and glucose (beta coefficient, 0.13; 95% CI, 0.06– 0.19) had the strongest positive association with CIMT in the Asian population when compared with all other racial and ethnic groups. High-density lipoprotein-cholesterol had significant protective effects in African American (beta coefficient, −0.31; 95% CI, −0.42 to −0.21) and African (beta coefficient, −0.26; 95% CI, −0.31 to −0.19) populations only. CONCLUSIONS: The strength of association between established cardiovascular risk factors and CIMT differed across the racial or ethnic groups and may be due to lifestyle risk factors and genetics. These differences have implications for race-ethnicity-specific primary prevention strategies and also give insights into the differential contribution of risk factors to the pathogenesis of cardiovascular disease. The greatest burden of subclinical atherosclerosis in African American individuals warrants further investigations.

Original languageEnglish
Article numbere023704
JournalJournal of the American Heart Association
Issue number15
Publication statusPublished - 2 Aug 2022

Bibliographical note

Sources of Funding
Nonterah is supported by a grant from the Global Health Support Program of the University Medical Center Utrecht (UMCU), Utrecht University, The Netherlands and the Navrongo Health Research Centre (NHRC), Ghana. The AWI‐Gen Collaborative Centre is funded by the National Human Genome Research Institute (NHGRI), Office of the Director (OD), Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), the National Institute of Environmental Health Sciences (NIEHS), the Office of AIDS Research (OAR), and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), of the National Institutes of Health (NIH) under award number U54HG006938 and its supplements, as part of the H3Africa Consortium. Additional funding was leveraged from the Department of Science and Technology, South Africa, award number DST/CON 0056/2014. The USE‐IMT project is supported by a grant from the Netherlands Organisation for Health Research and Development (ZonMw 200320003). The KIHD cohort was funded by grants from the Academy of Finland to Professor Jukka T. Salonen and from the NIH to Professor George A. Kaplan. The ARIC study is funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services under contract numbers HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, and HHSN268201700004I. The MESA study is sponsored by the National Heart, Lung and Blood Institute of the NIH. The authors thank the staff and participants of the ARIC and MESA studies for their important contributions. The views expressed in this article are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute, the NIH, or the US Department of Health and Human Services or the views of the other funders. The funders had no role in the design and conduct of the study; in the data collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the article.

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