Asia-Pacific Investigators and Asian Enrollment in Cardiometabolic Trials

Azzopardi, Robert; Nicholls, Stephen J.; Nerlekar, Nitesh; Scherer, Daniel; Chandramouli, Chanchal; Lam, Carolyn S.P.; Muthalaly, Rahul G.; Tan, Sean; Wong, Christopher X.; Chew, Derek P.; Zoungas, Sophia; Yeo, Khung Keong; Nelson, Adam

doi:10.1016/j.jacasi.2023.05.010

Cited by 5 publications

(6 citation statements)

References 31 publications

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“…Despite all these limitations, this study reports important data about the clinical management and the risk of adverse events in a large multinational cohort of Asian patients with AF and thus have a crucial impact in balancing the Asians underrepresentation into the studies on high-impact cardiometabolic conditions performed over the past 10 years [ 47 ].…”

Section: Discussionmentioning

confidence: 99%

Adverse Events and Clinical Correlates in Asian Patients with Atrial Fibrillation and Diabetes Mellitus: A Report from Asia Pacific Heart Rhythm Society Atrial Fibrillation Registry

Bucci,

Nabrdalik,

Shantsila

et al. 2024

JCM

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Aims. To evaluate the adverse events (and its clinical correlates) in a large prospective cohort of Asian patients with atrial fibrillation (AF) and diabetes mellitus (DM). Material and Methods. We recruited patients with atrial fibrillation (AF) from the Asia-Pacific Heart Rhythm Society (APHRS) AF Registry and included those for whom the diabetic mellitus (DM) status was known. We used Cox-regression analysis to assess the 1-year risk of all-cause death, thromboembolic events, acute coronary syndrome, heart failure and major bleeding. Results. Of 4058 patients (mean age 68.5 ± 11.8 years; 34.4% females) considered for this analysis, 999 (24.6%) had DM (age 71 ± 11 years, 36.4% females). Patients with DM had higher mean CHA2DS2-VASc (2.3 ± 1.6 vs. 4.0 ± 1.5, p < 0.001) and HAS-BLED (1.3 ± 1.0 vs. 1.7 ± 1.1, p < 0.001) risk scores and were less treated with rhythm control strategies compared to patients without DM (18.7% vs. 22.0%). After 1-year of follow-up, patients with DM had higher incidence of all-cause death (4.9% vs. 2.3%, p < 0.001), cardiovascular death (1.3% vs. 0.4%, p = 0.003), and major bleeding (1.8% vs. 0.9%, p = 0.002) compared to those without DM. On Cox regression analysis, adjusted for age, sex, heart failure, coronary and peripheral artery diseases and previous thromboembolic event, DM was independently associated with a higher risk of all-cause death (HR 1.48, 95% CI 1.00–2.19), cardiovascular death (HR 2.33, 95% CI 1.01–5.40), and major bleeding (HR 1.91, 95% 1.01–3.60). On interaction analysis, the impact of DM in determining the risk of all-cause death was greater in young than in older patients (p int = 0.010). Conclusions. Given the high rates of adverse outcomes in these Asian AF patients with DM, efforts to optimize the management approach of these high-risk patients in a holistic or integrated care approach are needed.

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Section: Discussionmentioning

confidence: 99%

Adverse Events and Clinical Correlates in Asian Patients with Atrial Fibrillation and Diabetes Mellitus: A Report from Asia Pacific Heart Rhythm Society Atrial Fibrillation Registry

Bucci,

Nabrdalik,

Shantsila

et al. 2024

JCM

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“…The underrepresentation of certain groups, often minorities, is disproportionate to the overall population characteristics. The underrepresentation of diverse populations is reflected in cardiogenetics research [8], as well as cardiovascular trials [60][61][62]. GWASs thus far have poorly represented Hispanic/Latino, African, South Asian, East Asian populations [59,63,64], and especially Indigenous populations globally [55,65].…”

Section: The Current State Of Cardiovascular Genetic Epidemiology For...mentioning

confidence: 99%

“…Given the sheer number of data points needed for wellpowered genetics studies, the cost-benefit in the case of large-scale biobank development is evident [147]. Funding is paramount in genetics research, and financial support for genetics studies in underrepresented populations illustrates the progress that can be made [61]. Simultaneously, care and culturally appropriate methods should be implemented in the building of such databases to ensure harm is not perpetuated and that population-specific contexts and goals are honoured [146,147].…”

Section: Support For Diverse Genetics Studiesmentioning

confidence: 99%

The Inclusion of Underrepresented Populations in Cardiovascular Genetics and Epidemiology

Chappell,

Arbour,

Laksman

2024

JCDD

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Novel genetic risk markers have helped us to advance the field of cardiovascular epidemiology and refine our current understanding and risk stratification paradigms. The discovery and analysis of variants can help us to tailor prognostication and management. However, populations underrepresented in cardiovascular epidemiology and cardiogenetics research may experience inequities in care if prediction tools are not applicable to them clinically. Therefore, the purpose of this article is to outline the barriers that underrepresented populations can face in participating in genetics research, to describe the current efforts to diversify cardiogenetics research, and to outline strategies that researchers in cardiovascular epidemiology can implement to include underrepresented populations. Mistrust, a lack of diverse research teams, the improper use of sensitive biodata, and the constraints of genetic analyses are all barriers for including diverse populations in genetics studies. The current work is beginning to address the paucity of ethnically diverse genetics research and has already begun to shed light on the potential benefits of including underrepresented and diverse populations. Reducing barriers for individuals, utilizing community-driven research processes, adopting novel recruitment strategies, and pushing for organizational support for diverse genetics research are key steps that clinicians and researchers can take to develop equitable risk stratification tools and improve patient care.

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“…Lam , MBBS, PhD; Nancy K. Sweitzer , MD, PhD A sia is the fastest-growing and most populous region of the world, accounting for 60% of the worldwide cardiovascular disease burden. 1 It is also vastly heterogeneous. The representation of "Asia" in clinical trials varies widely, spanning from Japan to India, and comprises <10% of cardiometabolic clinical trials enrollment.…”

Section: On My Mindmentioning

confidence: 99%

“…The representation of "Asia" in clinical trials varies widely, spanning from Japan to India, and comprises <10% of cardiometabolic clinical trials enrollment. 1 The lack of granularity in Asian ancestry data within these trials raises concerns about the generalizability of trial findings to this diverse population. This concern is particularly salient in the context of heart failure, which is a global health problem affecting millions of individuals and placing a significant burden on health systems.…”

Section: On My Mindmentioning

confidence: 99%

“Asian” Heart Failure

Yoo,

Lam,

Sweitzer

2024

Circulation

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Asia-Pacific Investigators and Asian Enrollment in Cardiometabolic Trials

Cited by 5 publications

References 31 publications

Adverse Events and Clinical Correlates in Asian Patients with Atrial Fibrillation and Diabetes Mellitus: A Report from Asia Pacific Heart Rhythm Society Atrial Fibrillation Registry

Adverse Events and Clinical Correlates in Asian Patients with Atrial Fibrillation and Diabetes Mellitus: A Report from Asia Pacific Heart Rhythm Society Atrial Fibrillation Registry

The Inclusion of Underrepresented Populations in Cardiovascular Genetics and Epidemiology

“Asian” Heart Failure

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