Abstract
BackgroundThe high frequency of premature death from cardiovascular disease in indigenous Australians is often attributed to the high prevalence of risk factors, especially type II diabetes mellitus (DM). We evaluated the relationship of ethnicity to atherosclerotic burden, as evidenced by carotid intima-media thickness (IMT), independent of risk factor status.MethodsWe studied 227 subjects (147 men; 50 ± 13 y): 119 indigenous subjects with (IDM, n = 54), and without DM (InDM, n = 65), 108 Caucasian subjects with (CDM, n = 52), and without DM (CnDM, n = 56). IMT was measured according to standard methods and compared with clinical data and cardiovascular risk factors.ResultsIn subjects both with and without DM, IMT was significantly greater in indigenous subjects. There were no significant differences in gender, body mass index (BMI), systolic blood pressure (SBP), or diastolic blood pressure (DBP) between any of the groups, and subjects with DM showed no difference in plasma HbA1c. Cardiovascular risk factors were significantly more prevalent in indigenous subjects. Nonetheless, ethnicity (β = -0.34; p < 0.0001), age (β = 0.48; p < 0.0001), and smoking (β = 0.13; p < 0.007) were independent predictors of IMT in multiple linear regression models.ConclusionEthnicity appears to be an independent correlate of preclinical cardiovascular disease, even after correction for the high prevalence of cardiovascular risk factors in indigenous Australians. Standard approaches to control currently known risk factors are vital to reduce the burden of cardiovascular disease, but in themselves may be insufficient to fully address the high prevalence in this population.
Highlights
The high frequency of premature death from cardiovascular disease in indigenous Australians is often attributed to the high prevalence of risk factors, especially type II diabetes mellitus (DM)
There was no significant difference in gender, body mass index (BMI) or diastolic blood pressure (DBP) in any of the groups, and there was no significant difference in plasma HbA1c between the indigenous and non-indigenous groups with DM
All of the groups had significantly greater intima-media thickness (IMT) compared to the CnDM group and both indigenous groups had significantly greater IMT compared with the non-indigenous groups, including the CDM group
Summary
The high frequency of premature death from cardiovascular disease in indigenous Australians is often attributed to the high prevalence of risk factors, especially type II diabetes mellitus (DM). Death rates are estimated to be four times higher in indigenous than in non-indigenous Australians. Coronary heart disease is 3–4 times higher for males and females than in non-indigenous people [10,11]. Indigenous people are much more likely to die of CVD than non-indigenous people at any age, especially in younger age groups – the death rate among 25–54 year olds was 10 times higher than other Australians
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