Heart attack, stroke, diabetes, and hypertension in West Indians, Asians, and whites in Birmingham, England.

Cruickshank, J.; Beevers, D. G.; Osbourne, V. L.; Haynes, Rebecca A.; Corlett, J C; Selby, Sarah Tolford

doi:10.1136/bmj.281.6248.1108

Cited by 106 publications

(62 citation statements)

References 3 publications

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“…Despite frequent high BP and excess diabetes in African-Caribbeans in Britain, 13,27 such a pattern reflects exactly that reported for 20 years in national morbidity 28 and mortality statistics in people with 29 or without 30 diabetes and is similar to that in Caribbean migrants to the United States. 31 However, the picture may well change with increasing smoking and dietary fat along with decreasing fruit and vegetable intakes in younger African-Caribbeans in Britain.…”

Section: Table 2 Baseline Clinical Characteristics Of the Subjects Bsupporting

confidence: 51%

Aortic Pulse-Wave Velocity and Its Relationship to Mortality in Diabetes and Glucose Intolerance

et al. 2002

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Background-Arterial distensibility measures, generally from pulse-wave velocity (PWV), are widely used with little knowledge of relationships to patient outcome. We tested whether aortic PWV predicts cardiovascular and all-cause mortality in type 2 diabetes and glucose-tolerance-tested (GTT) multiethnic population samples. Methods and Results-Participants were randomly sampled from (1) a type 2 diabetes outpatient clinic and (2) primary care population registers, from which nondiabetic control subjects were given a GTT. Brachial blood pressures and Doppler-derived aortic PWV were measured. Mortality data over 10 years' follow-up were obtained. At any level of systolic blood pressure (SBP), aortic PWV was greater in subjects with diabetes than in controls. Mortality risk doubled in subjects with diabetes (hazard ratio 2.34, 95% CI 1.5 to 3.74) and in those with glucose intolerance (2.12, 95% CI 1.11 to 4.0) compared with controls. For all groups combined, age, sex, and SBP predicted mortality; the addition of PWV independently predicted all-cause and cardiovascular mortality (hazard ratio 1.08, 95% CI 1.03 to 1.14 for each 1 m/s increase) but displaced SBP. Glucose tolerance status and smoking were other independent contributors, with African-Caribbeans experiencing reduced mortality risk (hazard ratio 0.41, 95% CI 0.25 to 0.69). Conclusions-Aortic PWV is a powerful independent predictor of mortality in both diabetes and GTT population samples.In displacing SBP as a prognostic factor, aortic PWV is probably further along the causal pathway for arterial disease and may represent a useful integrated index of vascular status and hence cardiovascular risk.

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Section: Table 2 Baseline Clinical Characteristics Of the Subjects Bsupporting

confidence: 51%

Aortic Pulse-Wave Velocity and Its Relationship to Mortality in Diabetes and Glucose Intolerance

et al. 2002

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“…For example, recent reports on CHD in the United States contrasted the lower CHD rates in AfCorigin migrants with the higher rates in AfricanAmericans although nutrient intake data were not available 4 . This pattern has also long been noted between AfC migrants to Britain and the national white European-origin population [5][6][7] . Thus, CHD mortality in Caribbean-born men has remained persistently 50% lower than the high national rates in British-born men, both 20 years ago and in the most recent data for 1988-92 7,8 , while that for AfC women has similarly been some 67-75% of national rates.…”

mentioning

confidence: 54%

Nutrient intake trends among African-Caribbeans in Britain: a migrant population and its second generation

Sharma

Cade

Riste

et al. 1999

Public Health Nutr.

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Objective: To explore British African-Caribbean (AfC) nutrient intake by migration status (place of birth), diet (traditional Caribbean or more European) and age and relate this ecologically to coronary heart disease (CHD) mortality rates. Design: Cross-sectional. Setting: Inner-city Manchester, UK. Subjects: Two hundred and fifty-five adults of AfC origin aged 25-79 years, randomly sampled from population registers. Results: Caribbean-born people (mean age 56, and mean time in Britain 30 years) had significantly lower per cent energy from total and saturated fat than younger Britishborn AfC people (mean age 29 years) (31.3% vs. 35%, difference in total fat 3.7%, 95%CI 2-5%; in saturated fat 10.9% vs. 12.6%, difference 1.7%, 95%CI 1-2.5%). The Caribbean-born group also ate more fruit (þ84 g day, 95%CI 36-132 g day) and green vegetables (þ26 g day ). Men following a traditional diet (у 5 days week ) similarly had a lower per cent energy from fat, at 30.4%, than less traditional eaters, at 33.1% (difference 2.7%, 95%CI 0.7-4.8%). African-Caribbean women, at relatively greater CHD risk than AfC men, had higher body mass indices (BMIs) than AfC men. Compared with national data, AfC subjects consumed some 7% and 5% less energy from total fat and saturated fat, respectively, with over 9% more from carbohydrate. However, there was marked convergence towards the national average in the youngest AfC groups aged 25-34 years, whatever their place of birth. Conclusions: Caribbean birthplace has an independent effect on total fat intake and percentage of energy from fat. Together with higher fruit and vegetable intake, these results are consistent with the dietary fat/antioxidant/CHD hypothesis. Keywords African-CaribbeanNutrient intake Coronary risk Migration Age Place of birth Food frequency questionnaire Differing disease rates between migrant, original and local populations have supplied vital clues to aetiology but studies combined with comparative nutritional data are few [1][2][3] . For example, recent reports on CHD in the United States contrasted the lower CHD rates in AfCorigin migrants with the higher rates in AfricanAmericans although nutrient intake data were not available 4 . This pattern has also long been noted between AfC migrants to Britain and the national white European-origin population [5][6][7] . Thus, CHD mortality in Caribbean-born men has remained persistently 50% lower than the high national rates in British-born men, both 20 years ago and in the most recent data for 1988-92 7,8 , while that for AfC women has similarly been some 67-75% of national rates. However, CHD mortality in Jamaica was still less than half that of Caribbean-born people in the UK for these periods 9 again indicating that risk factors for CHD may have been acquired recently.The AfC community in Britain has primarily developed from the young people who migrated from the English-speaking West Indies in the 1950s and 1960s, and from their descendants now born in Britain 10. Similar migration occurred to the United States...

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“…The mean age of all first strokes was 71.7 years (range 0 to 106(SD 14.3)). The mean age was 73.9 years for white patients (range 0 to 106 (SD 13)), 62.6 years for black patients (range 17 to 94 (SD 15.5)), and 66 years for others (range 29 Incidence rates (age adjusted to the standard European population) were higher in males than females. The total crude rate in men was 1.35 (95% CI 1.39 to 1.64) and in women 1.33 (95% CI 0.98 to 1.15).…”

Section: Resultsmentioning

confidence: 97%

“…Differences in genetic, physiological, and behavioural risk factors accounting for ethnic differences in stroke incidence do require further elucidation. A higher prevalence of hypertension and diabetes among black subjects compared with white subjects has been reported 29 and a recent study suggests ethnic differences in genetic predisposition to hypertension. 30 Hart et al have shown that the adjusted hazard ratios for incidence with socioeconomic class 1 as baseline was 1.62 (95% CI 0.9 to 2.89) when adjusted for age and 1.24 (95% CI 0.69 to 2.24) when controlled for stroke risk factors.…”

Section: Risk Factorsmentioning

confidence: 90%

Incidence and case fatality rates of stroke subtypes in a multiethnic population: the South London Stroke Register

Wolfe¹,

Rudd

Howard

et al. 2002

Journal of Neurology, Neurosurgery &Amp; Psychiatry

198

150

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Objective: To identify sociodemographic differences in the incidence of the subtypes of first ever stroke in a multiethnic population. Methods: A prospective community stroke register was developed using multiple notification sources and pathological and clinical classifications of stroke. Standardisation of rates was to European and World populations and adjusted for age, sex and socioeconomic status in multivariate analyses. A multiethnic population of 234 533 in south London, of whom 21% are black was studied. Results: A total of 1254 cases were registered. The average age of stroke was 71.7 years with black patients being 11.3 years younger than white patients (p<0.0001). The incidence rate/1000 population was 1.33 (crude) (95% CI 1.26 to 1.41), 1.28 (European adjusted) (95% CI 1.2 to 1.35) with a 2.18 (95% CI 1.86 to 2.56) (p<0.0001) age and sex adjusted incidence rate ratio in the black population. Radiological diagnosis was confirmatory in 1107 (88.3%) with 862 (68.7%) infarction, 168 (13.4%) primary intracerebral haemorrhage, and 77 (6.2%) subarachnoid haemorrhage. Of the cerebral infarction cases 189 (21.9%) were total anterior circulatory, 250 (29%) partial anterior, 141 (16.4%) posterior (POCI) and 282 (32.7%) lacunar infarcts. The black group had a significantly higher incidence of all subtypes of stroke except for POCI and unclassified strokes. The incidence rate ratio (IRR) for men compared with women was 1.34 (95% confidence interval (95% CI) 1.19 to 1.50; p<0.001). The IRR for manual versus non-manual occupations in those aged 35-64 years was 1.64 (95%CI 1.22 to 2.23; p<0.0001). There was a borderline significant increase in adjusted survival at 6 months in the black group 95% (CI 0.61 to 1.03, p=0.078) with a hazard ratio of 0.79 after adjustment and stratification. Conclusions: Although the black population is at increased risk of stroke and most subtypes of stroke, this is not translated into significant differences in survival. Hence black/white differences in mortality are mainly driven by incidence of stroke. There are striking demographic inequalities in the risk of stroke in this multiethnic inner city population that need to be tackled through interagency working. Although the reasons for the increased risk in the black population are unclear, demographic factors such as socioeconomic status do seem to play a significant independent part.

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Heart attack, stroke, diabetes, and hypertension in West Indians, Asians, and whites in Birmingham, England.

Cited by 106 publications

References 3 publications

Aortic Pulse-Wave Velocity and Its Relationship to Mortality in Diabetes and Glucose Intolerance

Aortic Pulse-Wave Velocity and Its Relationship to Mortality in Diabetes and Glucose Intolerance

Nutrient intake trends among African-Caribbeans in Britain: a migrant population and its second generation

Incidence and case fatality rates of stroke subtypes in a multiethnic population: the South London Stroke Register

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