TY - JOUR
T1 - Obesity, Diabetes, and Acute Coronary Syndrome
T2 - Differences Between Asians and Whites
AU - Koshizaka, Masaya
AU - Lopes, Renato D.
AU - Newby, L. Kristin
AU - Clare, Robert M.
AU - Schulte, Phillip J.
AU - Tricoci, Pierluigi
AU - Mahaffey, Kenneth W.
AU - Ogawa, Hisao
AU - Moliterno, David J.
AU - Giugliano, Robert P.
AU - Huber, Kurt
AU - James, Stefan
AU - Harrington, Robert A.
AU - Alexander, John H.
N1 - Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2017/10
Y1 - 2017/10
N2 - Background Most diabetes and cardiovascular studies have been conducted in white patients, with data being extrapolated to other population groups. Methods For this analysis, patient-level data were extracted from 5 randomized clinical trials in patients with acute coronary syndrome; we compared obesity levels between Asian and white populations, stratified by diabetes status. By using an adjusted Cox proportional hazards model, hazard ratios (HRs) for cardiovascular outcomes after an acute coronary syndrome were determined. Results We identified 49,224 patient records from the 5 trials, with 3176 Asians and 46,048 whites. Whites with diabetes had higher body mass index values than those without diabetes (median 29.3 vs 27.2 kg/m2; P <.0001), whereas Asians with diabetes and without diabetes had similar body mass index (24.7 vs 24.2 kg/m2). Asians with diabetes (HR, 1.63; 95% confidence interval [CI], 1.32-2.02), whites with diabetes (HR, 1.15; 95% CI, 1.06-1.25), and Asians without diabetes (HR, 1.36; 95% CI, 1.14-1.64) had higher rates of the composite of death, myocardial infarction, or stroke at 30 days than whites without diabetes. Asians with diabetes (HR, 1.84; 95% CI, 1.47-2.31), whites with diabetes (HR, 1.47; 95% CI, 1.33-1.62), and Asians without diabetes (HR, 1.38; 95% CI, 1.11-1.73) had higher rates of death at 1 year compared with whites without diabetes. There were no significant interactions between race and diabetes for ischemic outcomes. Conclusions Although Asians with diabetes and acute coronary syndrome are less likely to be obese than their white counterparts, their risk for death or recurrent ischemic events was not lower.
AB - Background Most diabetes and cardiovascular studies have been conducted in white patients, with data being extrapolated to other population groups. Methods For this analysis, patient-level data were extracted from 5 randomized clinical trials in patients with acute coronary syndrome; we compared obesity levels between Asian and white populations, stratified by diabetes status. By using an adjusted Cox proportional hazards model, hazard ratios (HRs) for cardiovascular outcomes after an acute coronary syndrome were determined. Results We identified 49,224 patient records from the 5 trials, with 3176 Asians and 46,048 whites. Whites with diabetes had higher body mass index values than those without diabetes (median 29.3 vs 27.2 kg/m2; P <.0001), whereas Asians with diabetes and without diabetes had similar body mass index (24.7 vs 24.2 kg/m2). Asians with diabetes (HR, 1.63; 95% confidence interval [CI], 1.32-2.02), whites with diabetes (HR, 1.15; 95% CI, 1.06-1.25), and Asians without diabetes (HR, 1.36; 95% CI, 1.14-1.64) had higher rates of the composite of death, myocardial infarction, or stroke at 30 days than whites without diabetes. Asians with diabetes (HR, 1.84; 95% CI, 1.47-2.31), whites with diabetes (HR, 1.47; 95% CI, 1.33-1.62), and Asians without diabetes (HR, 1.38; 95% CI, 1.11-1.73) had higher rates of death at 1 year compared with whites without diabetes. There were no significant interactions between race and diabetes for ischemic outcomes. Conclusions Although Asians with diabetes and acute coronary syndrome are less likely to be obese than their white counterparts, their risk for death or recurrent ischemic events was not lower.
KW - Acute coronary syndrome
KW - Diabetes
KW - Ischemic outcomes
KW - Obesity
KW - Race
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U2 - 10.1016/j.amjmed.2017.03.030
DO - 10.1016/j.amjmed.2017.03.030
M3 - Article
C2 - 28396226
AN - SCOPUS:85020062042
SN - 0002-9343
VL - 130
SP - 1170
EP - 1176
JO - American Journal of Medicine
JF - American Journal of Medicine
IS - 10
ER -