Carotid Atherosclerosis in People of European, South Asian and African Caribbean Ethnicity in the Southall and Brent Revisited Study (SABRE)

Overview

Journal Front Cardiovasc Med

Specialty Cardiology & Vascular Diseases

Date 2023 Feb 10

PMID 36762303

Authors

Rayan Anbar

Nish Chaturvedi

Sophie V Eastwood

Therese Tillin

Alun D Hughes

Affiliations

Soon will be listed here.

Abstract

Background: Atherosclerotic cardiovascular disease (ASCVD) risk differs by ethnicity. In comparison with Europeans (EA) South Asian (SA) people in UK experience higher risk of coronary heart disease (CHD) and stroke, while African Caribbean people have a lower risk of CHD but a higher risk of stroke.

Aim: To compare carotid atherosclerosis in EA, SA, and AC participants in the Southall and Brent Revisited (SABRE) study and establish if any differences were explained by ASCVD risk factors.

Methods: Cardiovascular risk factors were measured, and carotid ultrasound was performed in 985 individuals (438 EA, 325 SA, 228 AC). Carotid artery plaques and intima-media thickness (cIMT) were measured. Associations of carotid atherosclerosis with ethnicity were investigated using generalised linear models (GLMs), with and without adjustment for non-modifiable (age, sex) and modifiable risk factors (education, diabetes, hypertension, total cholesterol, HDL-C, alcohol consumption, current smoking).

Results: Prevalence of any plaque was similar in EA and SA, but lower in AC (16, 16, and 6%, respectively; < 0.001). In those with plaque, total plaque area, numbers of plaques, plaque class, or greyscale median did not differ by ethnicity; adjustment for risk factors had minimal effects. cIMT was higher in AC than the other ethnic groups after adjustment for age and sex, adjustment for risk factors attenuated this difference.

Conclusion: Prevalence of carotid artery atherosclerotic plaques varies by ethnicity, independent of risk factors. Lower plaque prevalence in in AC is consistent with their lower risk of CHD but not their higher risk of stroke. Higher cIMT in AC may be explained by risk factors. The similarity of plaque burden in SA and EA despite established differences in ASCVD risk casts some doubt on the utility of carotid ultrasound as a means of assessing risk across these ethnic groups.

Citing Articles

Analysis of carotid ultrasound in a high-stroke-risk population.

Wang C, Geng L, Hou L Medicine (Baltimore). 2024; 103(44):e40383.

PMID: 39496038 PMC: 11537612. DOI: 10.1097/MD.0000000000040383.

Gray-Scale Median in Patients with Symptomatic and Asymptomatic Carotid Atherosclerosis-Risk Factors and Diagnostic Potential.

Plonski A, Pawlak D, Plonski A, Glowinski J, Madycki G, Pawlak K Biomedicines. 2024; 12(7).

PMID: 39062167 PMC: 11274489. DOI: 10.3390/biomedicines12071594.

Associations of carotid atherosclerosis with cognitive function and brain health: Findings from a UK tri-ethnic cohort study (Southall and Brent Revisited).

Anbar R, Jones S, Chaturvedi N, Sudre C, Richards M, Sultan S Atheroscler Plus. 2024; 55:39-46.

PMID: 38371883 PMC: 10874717. DOI: 10.1016/j.athplu.2024.01.002.

The prevalence of extracranial carotid atherosclerosis detected via ultrasound imaging: A single-centre study in Jeddah, Saudi Arabia.

Sultan S Saudi Med J. 2024; 45(1):69-73.

PMID: 38220238 PMC: 10807664. DOI: 10.15537/smj.2024.45.1.20230503.

Ethnic Differences in Carotid Intima-Media Thickness and Plaque Presence: The HELIUS Study.

Vriend E, Bouwmeester T, Artola Arita V, Bots M, Meijer R, Galenkamp H Cerebrovasc Dis. 2023; 53(5):618-624.

PMID: 38091958 PMC: 11446328. DOI: 10.1159/000535713.

References

. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017; 390(10100):1151-1210. PMC: 5605883. DOI: 10.1016/S0140-6736(17)32152-9. View

Tillin T, Hughes A, Mayet J, Whincup P, Sattar N, Forouhi N . The relationship between metabolic risk factors and incident cardiovascular disease in Europeans, South Asians, and African Caribbeans: SABRE (Southall and Brent Revisited) -- a prospective population-based study. J Am Coll Cardiol. 2013; 61(17):1777-86. PMC: 3677086. DOI: 10.1016/j.jacc.2012.12.046. View

Wendelhag I, Liang Q, Gustavsson T, Wikstrand J . A new automated computerized analyzing system simplifies readings and reduces the variability in ultrasound measurement of intima-media thickness. Stroke. 1997; 28(11):2195-200. DOI: 10.1161/01.str.28.11.2195. View

Jones S, Tillin T, Park C, Williams S, Rapala A, Al Saikhan L . Cohort Profile Update: Southall and Brent Revisited (SABRE) study: a UK population-based comparison of cardiovascular disease and diabetes in people of European, South Asian and African Caribbean heritage. Int J Epidemiol. 2020; 49(5):1441-1442e. PMC: 7746410. DOI: 10.1093/ije/dyaa135. View

Al Saikhan L, Alobaida M, Bhuva A, Chaturvedi N, Heasman J, Hughes A . Imaging Protocol, Feasibility, and Reproducibility of Cardiovascular Phenotyping in a Large Tri-Ethnic Population-Based Study of Older People: The Southall and Brent Revisited (SABRE) Study. Front Cardiovasc Med. 2020; 7:591946. PMC: 7693529. DOI: 10.3389/fcvm.2020.591946. View

OBrien E, Asmar R, Beilin L, Imai Y, Mancia G, Mengden T . Practice guidelines of the European Society of Hypertension for clinic, ambulatory and self blood pressure measurement. J Hypertens. 2005; 23(4):697-701. DOI: 10.1097/01.hjh.0000163132.84890.c4. View

MacKinnon A, Jerrard-Dunne P, Porteous L, Markus H . Carotid intima-media thickness is greater but carotid plaque prevalence is lower in black compared with white subjects. AJNR Am J Neuroradiol. 2010; 31(10):1951-5. PMC: 7964013. DOI: 10.3174/ajnr.A2214. View

. North American Symptomatic Carotid Endarterectomy Trial. Methods, patient characteristics, and progress. Stroke. 1991; 22(6):711-20. DOI: 10.1161/01.str.22.6.711. View

Banerjee S, Cader F, Gulati M, Capers 4th Q . Racism and Cardiology: A Global Call to Action. CJC Open. 2022; 3(12 Suppl):S165-S173. PMC: 8712707. DOI: 10.1016/j.cjco.2021.09.014. View

10.

Kuller L . Ethnic differences in atherosclerosis, cardiovascular disease and lipid metabolism. Curr Opin Lipidol. 2004; 15(2):109-13. DOI: 10.1097/00041433-200404000-00003. View

11.

Benjamin I, Brown N, Burke G, Correa A, Houser S, Jones D . American Heart Association Cardiovascular Genome-Phenome Study: foundational basis and program. Circulation. 2014; 131(1):100-12. PMC: 4286232. DOI: 10.1161/CIRCULATIONAHA.114.014190. View

12.

Stein J, Korcarz C, Hurst R, Lonn E, Kendall C, Mohler E . Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Endorsed by the Society for.... J Am Soc Echocardiogr. 2008; 21(2):93-111. DOI: 10.1016/j.echo.2007.11.011. View

13.

Touboul P, Hennerici M, Meairs S, Adams H, Amarenco P, Bornstein N . Mannheim carotid intima-media thickness and plaque consensus (2004-2006-2011). An update on behalf of the advisory board of the 3rd, 4th and 5th watching the risk symposia, at the 13th, 15th and 20th European Stroke Conferences, Mannheim, Germany,.... Cerebrovasc Dis. 2012; 34(4):290-6. PMC: 3760791. DOI: 10.1159/000343145. View

14.

Javed Z, Maqsood M, Yahya T, Amin Z, Acquah I, Valero-Elizondo J . Race, Racism, and Cardiovascular Health: Applying a Social Determinants of Health Framework to Racial/Ethnic Disparities in Cardiovascular Disease. Circ Cardiovasc Qual Outcomes. 2022; 15(1):e007917. DOI: 10.1161/CIRCOUTCOMES.121.007917. View

15.

Yusuf S, Joseph P, Rangarajan S, Islam S, Mente A, Hystad P . Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE): a prospective cohort study. Lancet. 2019; 395(10226):795-808. PMC: 8006904. DOI: 10.1016/S0140-6736(19)32008-2. View

16.

GRAHAM J, Burnett J, Byrne K, Lusby R . Carotid artery atheroma: comparison of preoperative B-mode ultrasound appearance with carotid endarterectomy specimen pathology. J Cardiovasc Surg (Torino). 1988; 29(6):676-81. View

17.

Eriksen A, Tillin T, OConnor L, Brage S, Hughes A, Mayet J . The impact of health behaviours on incident cardiovascular disease in Europeans and South Asians--a prospective analysis in the UK SABRE study. PLoS One. 2015; 10(3):e0117364. PMC: 4346401. DOI: 10.1371/journal.pone.0117364. View

18.

Eastwood S, Tillin T, Dehbi H, Wright A, Forouhi N, Godsland I . Ethnic differences in associations between fat deposition and incident diabetes and underlying mechanisms: the SABRE study. Obesity (Silver Spring). 2015; 23(3):699-706. PMC: 4463764. DOI: 10.1002/oby.20997. View

19.

Tillin T, Forouhi N, McKeigue P, Chaturvedi N . Southall And Brent REvisited: Cohort profile of SABRE, a UK population-based comparison of cardiovascular disease and diabetes in people of European, Indian Asian and African Caribbean origins. Int J Epidemiol. 2010; 41(1):33-42. PMC: 3304519. DOI: 10.1093/ije/dyq175. View

20.

Freedman B, Hsu F, Langefeld C, Rich S, Herrington D, Carr J . The impact of ethnicity and sex on subclinical cardiovascular disease: the Diabetes Heart Study. Diabetologia. 2005; 48(12):2511-8. DOI: 10.1007/s00125-005-0017-2. View