Obesity, Diabetes, and Acute Coronary Syndrome: Differences between Asians and Whites, The American Journal of Medicine, Masaya Koshizaka, a, b, , , Renato D. Lopes, a, L. Kristin Newby, a, Robert M. Clare, a, Phillip J. Schulte, a, Pierluigi Tricoci, a, Kenneth W. Mahaffey,c, Hisao Ogawa, d, David J. Moliterno, e, Robert P. Giugliano, f, Kurt Huber, g, Stefan James, h, Robert A. Harrington, c, John H. Alexander, a
- a Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
- b Division of Diabetes, Metabolism and Endocrinology, Clinical Research Center, Chiba University Hospital, Chiba, Japan
- c Department of Medicine, Stanford University, Stanford, CA
- d Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
- e Gill Heart Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY
- f Division of Cardiovascular Medicine, TIMI Study Group, Brigham and Women’s Hospital, Boston, MA
- g 3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Vienna, Austria
- h Department of Medical Sciences, Cardiology, Uppsala University and Uppsala Clinical Research Center, Uppsala, Sweden
Most diabetes and cardiovascular studies have been conducted in white patients, with data being extrapolated to other population groups.
For this analysis, patient-level data were extracted from five randomized clinical trials in patients with acute coronary syndrome; we compared obesity levels between Asian and white populations, stratified by diabetes status. Using an adjusted Cox proportional hazards model, hazard ratios for cardiovascular outcomes following an acute coronary syndrome were determined.
We identified 49,224 patient records from the five trials, with 3176 Asians and 46,048 whites. Whites with diabetes had higher body mass index (BMI) values than those without diabetes (median 29.3 vs. 27.2 kg/m2; P<0.0001), while Asians with diabetes and without diabetes had similar BMIs (24.7 vs. 24.2 kg/m2). Asians with diabetes (hazard ratio [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.
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.