Comment on Shah et al. Cardiovascular Complications and Mortality After Diabetes Diagnosis for South Asian and Chinese Patients: A Population-Based Cohort Study. Diabetes Care 2013;36:2670–2676

Tillin, Therese; Sattar, Naveed; Forouhi, Nita G.; Hughes, Alun D.; Chaturvedi, Nish

doi:10.2337/dc13-2490

Cited by 2 publications

(2 citation statements)

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“…In accordance with previous studies, this study reported differences in CVD and cancer risk between white European and South Asian participants 11 25 26. In the future, it might be important to consider that when the high CVD risk among South Asians is better managed in these populations, this may impact on cancer risk.…”

Section: Discussionsupporting

confidence: 90%

“…Therefore, participants within the current study had a longer duration of T2D. Additionally, the study by Shah et al 10 did not adjust for smoking or adiposity levels,25 with smoking rates generally much lower (as is also the case in this study) among South Asians compared with white Europeans. Study settings may also have led to the contrasting results, with the current study conducted in the UK and the study by Shah et al 10 conducted in Canada.…”

Section: Discussionmentioning

confidence: 64%

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Contribution of type 2 diabetes to all-cause mortality, cardiovascular disease incidence and cancer incidence in white Europeans and South Asians: findings from the UK Biobank population-based cohort study

Muilwijk¹,

Waddell

et al. 2019

BMJ Open Diab Res Care

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ObjectiveTo investigate whether the health implications of having type 2 diabetes (T2D) were different in South Asian compared with white European participants.Research design and methodsProspective data from UK Biobank were used, and 457 935 participants of white European and 7102 of South Asian background were included. Cox proportional regression was performed to investigate the association between T2D and health outcome by ethnicity.ResultsOver a mean of 7.0 years (IQR 6.3–7.6) of follow-up, 12 974 participants had died, and 30 347 and 27 159 developed cardiovascular disease (CVD) and cancer, respectively. South Asians had a higher risk for CVD mortality (HR: 1.42, 95% CI 1.07 to 1.89) and incidence (HR: 1.78, 95% CI 1.63 to 1.94), but a decreased risk for cancer mortality (HR: 0.59, 95% CI 0.41 to 0.85) and incidence (HR: 0.80, 95% CI 0.70 to 0.92) compared with white Europeans. Compared with individuals without T2D, both white Europeans and South Asians with T2D had a higher risk for all-cause mortality (1.59 (1.48 to 1.71) vs 2.83 (1.76 to 4.53)), CVD mortality (2.04 (1.82 to 2.28) vs 4.40 (2.37 to 8.16)) and CVD incidence (1.37 (1.31 to 1.44) vs 1.60 (1.31 to 1.95)), respectively. However, the magnitude of the risk was higher for South Asians than white Europeans.ConclusionsAlthough T2D was associated with a higher risk for all-cause mortality and CVD incidence and mortality, in both white Europeans and South Asians, the risk experienced by South Asians with T2D was higher than their white European counterparts.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 64%

Contribution of type 2 diabetes to all-cause mortality, cardiovascular disease incidence and cancer incidence in white Europeans and South Asians: findings from the UK Biobank population-based cohort study

Muilwijk¹,

Waddell

et al. 2019

BMJ Open Diab Res Care

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View full text Add to dashboard Cite

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Response to Comment on Shah et al. Cardiovascular Complications and Mortality After Diabetes Diagnosis for South Asian and Chinese Patients: A Population-Based Cohort Study. Diabetes Care 2013;36:2670–2676

et al. 2014

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We wish to thank Tillin et al. (1) for their comments on our study (2). We agree that the absence of information on smoking status from population-level health care administrative data limits our ability to adjust for this important cardiovascular risk factor, and that this and other unmeasured risk factors could confound the relationships we found between ethnicity and cardiovascular complications or mortality. However, as noted in the article, we conducted sensitivity analyses to see how imbalanced an unmeasured confounder would have to be to explain the observed results. A risk factor that quadrupled the risk for mortality would have to have a prevalence of 5% in the South Asian population and 30% in the European population to explain the observed reduced hazard for mortality. Compared with this hypothetical risk factor, cigarette smoking is both less potent as a risk factor and less imbalanced in prevalence in the Ontario population (3,4); hence, it is unlikely that it explains the striking difference in mortality observed in our study.

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Comment on Shah et al. Cardiovascular Complications and Mortality After Diabetes Diagnosis for South Asian and Chinese Patients: A Population-Based Cohort Study. Diabetes Care 2013;36:2670–2676

Cited by 2 publications

References 5 publications

Contribution of type 2 diabetes to all-cause mortality, cardiovascular disease incidence and cancer incidence in white Europeans and South Asians: findings from the UK Biobank population-based cohort study

Contribution of type 2 diabetes to all-cause mortality, cardiovascular disease incidence and cancer incidence in white Europeans and South Asians: findings from the UK Biobank population-based cohort study

Response to Comment on Shah et al. Cardiovascular Complications and Mortality After Diabetes Diagnosis for South Asian and Chinese Patients: A Population-Based Cohort Study. Diabetes Care 2013;36:2670–2676

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