Abstract
Background. Each year, approximately 5000 New Zealanders are admitted to hospital with first-time acute coronary syndrome (ACS). The Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS) is a prospective longitudinal cohort study embedded within the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry in six hospitals. The objective of MENZACS is to examine the relationship between clinical, genomic, and cardiometabolic markers in relation to presentation and outcomes post-ACS. Methods. Patients with first-time ACS are enrolled and study-specific research data is collected alongside the ANZACS-QI registry. The research blood samples are stored for future genetic/biomarker assays. Dietary information is collected with a food frequency questionnaire and information about physical activity, smoking, and stress is also collected via questionnaire. Detailed family history, ancestry, and ethnicity data are recorded on all participants. Results. During the period between 2015 and 2019, there were 2015 patients enrolled. The mean age was 61 years, with 60% of patients aged <65 years and 21% were female. Ethnicity and cardiovascular (CV) risk factor distribution was similar to ANZACS-QI: 13% Māori, 5% Pacific, 5% Indian, and 74% NZ European. In terms of CV risk factors, 56% were ex-/current smokers, 42% had hypertension, and 19% had diabetes. ACS subtype was ST elevation myocardial infarction (STEMI) in 41%, non-ST elevation myocardial infarction (NSTEM) in 54%, and unstable angina in 5%. Ninety-nine percent of MENZACS participants underwent coronary angiography and 90% had revascularization; there were high rates of prescription of secondary prevention medications upon discharge from hospital. Conclusion. MENZACS represents a cohort with optimal contemporary management and will be a significant epidemiological bioresource for the study of environmental and genetic factors contributing to ACS in New Zealand’s multi-ethnic environment. The study will utilise clinical, nutritional, lifestyle, genomic, and biomarker analyses to explore factors influencing the progression of coronary disease and develop risk prediction models for health outcomes.
Highlights
In New Zealand, 15% of all deaths annually are caused by ischaemic heart disease [1]and one in four major coronary events are fatal [2]
Subsequent outcomes; Can risk stratification be refined using clinical, biomarker, genetic, and epigenetic factors to build on existing secondary risk equations in New Zealand [27]; Association studies of genetic variants with first time acute coronary syndrome (ACS) and subsequent outcomes; The interaction of genomics, environmental factors, and biomarkers associated with certain phenotypes; Pharmacogenetic variability and the frequency of certain known variants across a diverse New Zealand population; Ethnic variation in genomic and genetic “signatures” related to cardiovascular risk factors
MENZACS has been established as a significant epidemiological bioresource for the study of environmental and genetic factors contributing to ACS in New Zealand’s contemporary ethnically diverse population
Summary
In New Zealand, 15% of all deaths annually are caused by ischaemic heart disease [1]. The broad themes of the proposed research are as follows: (1) to explore the role of genetic variation in the progression of coronary disease in a contemporary cohort of New. Zealanders with ACS; (2) to refine screening strategies in certain high-risk populations to enhance secondary risk prediction and early intervention using a combination of clinical risk factors, genomics, and biomarkers; and (3) to define how the response to therapies. Cardiogenetics 2021, 11, FOR PEER REVIEW enhance secondary risk prediction and early intervention using a combination of clinical risk factors, genomics, and biomarkers; and (3) to define how the response to therapies for ACS differs by ethnicity across New Zealand’s diverse ethnic population groups. Protocol and structure of the study are reported along with a description of the initial cohort
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