"Based on previous studies, we expected South Asians would have higher rates of heart disease - in fact, the American Heart Association now considers South Asian ethnicity a 'risk enhancer' beyond the standard risk calculator," Dr. Amit Khera of Massachusetts General Hospital in Boston said in a news release.
However, "Our current tools do not help us predict this extra risk in the South Asian population, likely because no South Asians were included in developing the U.S. tool, so we may be missing opportunities to prevent heart attacks and strokes in this group," Dr. Khera said.
Using data from the UK Biobank, the researchers evaluated 8,124 participants of South Asian ancestry and more than 449,000 of European ancestry who did not have ASCVD at enrollment between 2006 and 2010. Their average age at enrollment was 57 years.
During follow-up lasting an average of 11 years, 6.8% of people of South Asian ancestry had a CVD event compared to 4.4% of those of European ancestry.
After adjusting for age and sex, this represents a roughly two-fold higher risk for people of South Asian descent (hazard ratio, 2.03; 95% confidence interval, 1.86 to 2.22).
"The higher risk was largely consistent across a range of age, sex and clinical subgroups," the study team reports in Circulation.
However, despite the considerably higher risk, the predicted 10-year risk of CVD according to the American Heart Association/American College of Cardiology Pooled Cohort equations and QRISK3 equations was "nearly identical" for individuals of South Asian and European ancestry, the researchers point out.
Risk factors for heart disease, including diabetes, hypertension and increased central adiposity, were all more common in the South Asian study group. However, even after accounting for these differences, the CVD risk remained 45% higher in South Asians than Europeans (hazard ratio, 1.45; 95% CI, 1.28 to 1.65).
"We need to dig deeper to better understand why South Asians are having heart attacks and strokes at higher rates even after accounting for these risk factors," Dr. Aniruddh Patel of Massachusetts General Hospital, who also worked on the study, said in the news release.
"Our ability to study South Asian and other populations in general in the United States using public databases has been limited because individuals are grouped together by race rather than ancestry. This makes recognizing and addressing these disparities among a fast-growing South Asian population in the U.S. more difficult. In addition to recruiting more South Asians in clinical trials and cohort studies, better reporting of ancestry in addition to race in hospital data systems and electronic medical records would help us better understand and target these disparities," Dr. Patel added.
The researchers have assembled an international team to aggregate data and expertise needed to develop new genetic risk estimators for South Asian individuals as part of an effort funded by the National Institutes of Health (NIH).
SOURCE: https://bit.ly/3ASxV4q Circulation, online July 12, 2021.
By Reuters Staff
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