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Obesity, Diabetes, and Acute Coronary Syndrome: Differences Between Asians and Whites
Duke Univ, Med Ctr, Duke Clin Res Inst, Durham, NC USA.;Chiba Univ Hosp, Clin Res Ctr, Div Diabet Metab & Endocrinol, Chiba, Japan..
Duke Univ, Med Ctr, Duke Clin Res Inst, Durham, NC USA..
Duke Univ, Med Ctr, Duke Clin Res Inst, Durham, NC USA..
Duke Univ, Med Ctr, Duke Clin Res Inst, Durham, NC USA..
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2017 (English)In: American Journal of Medicine, ISSN 0002-9343, E-ISSN 1555-7162, Vol. 130, no 10, p. 1170-1176Article in journal (Refereed) Published
Abstract [en]

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/m(2); 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.

Place, publisher, year, edition, pages
2017. Vol. 130, no 10, p. 1170-1176
Keywords [en]
Acute coronary syndrome, Diabetes, Ischemic outcomes, Obesity, Race
National Category
Endocrinology and Diabetes
Identifiers
URN: urn:nbn:se:uu:diva-336301DOI: 10.1016/j.amjmed.2017.03.030ISI: 000410998300034PubMedID: 28396226OAI: oai:DiVA.org:uu-336301DiVA, id: diva2:1176831
Available from: 2018-01-23 Created: 2018-01-23 Last updated: 2018-01-23Bibliographically approved

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James, Stefan

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