Hemostatic cardiovascular risk factors, common carotid–intima medial thickness and peripheral arterial disease in South Asians and African Caribbeans: a substudy to the Ethnic‐Echocardiographic Heart of England Screening (E‐ECHOES) Study

Abstract

To cite this article: Bennett PC, Gill PS, Silverman S, Blann AD, Chackathayil J, Lip GYH. Hemostatic cardiovascular risk factors, common carotidintima medial thickness and peripheral arterial disease in South Asians and African Caribbeans: a substudy to the Ethnic-Echocardiographic Heart of England Screening (E-ECHOES) Study. J Thromb Haemost 2011; 9: 645-52.Summary. Objective: To determine whether ethnic differences exist in inflammatory (interleukin-6 and C-reactive protein) and hemostatic biomarkers (soluble P-selectin [sP-sel], von Willebrand factor [VWF], and fibrin D-dimer) between South Asian (people originating from India, Pakistan, and Bangladesh) and African Caribbean (Black Caribbean and Black African) groups, the two largest minority ethnic groups in the UK; and to determine associations between these biomarkers and common carotid intima-media thickness and peripheral artery disease (PAD). Patients and methods: We recruited 572 subjects (356 South Asian and 216 Black) aged ‡ 45 years as a substudy to a community screening project, the Ethnic-Echocardiographic Heart of England Screening (E-ECHOES) study. All subjects completed an interviewer-led questionnaire, anthropometric measurements were taken, and blood sampling was performed if consent was granted. Ankle brachial pressure index (ABPI) was calculated, and the common carotid intimamedia thickness (CCIMT) was measured. PAD was defined as ABPI < 0.9. ELISA was used to quantify inflammatory and hemostatic biomarkers. Results: The incidence of hypertension (> 70%) and diabetes (> 27%) was high, but non-significantly different between the two ethnic groups. South Asians had higher platelet count and sP-sel levels than African Caribbeans (P < 0.0001 for both), despite there being no significant difference in antiplatelet medication. African Caribbeans had higher D-dimer levels (P = 0.0052). Among South Asians, VWF correlated with ABPI (P = 0.047) and mean (P = 0.002) and maximum CCIMT (P = 0.011) on univariate analysis, and remained an independent predictor of mean and maximum CCIMT on multivariate analysis with traditional cardiovascular risk factors (P = 0.034 and P = 0.046, respectively). In African Caribbeans, D-dimer levels were was higher in PAD than in normal ABPI participants (P = 0.04), and was associated with ABPI in both univariate analysis (P = 0.014) and multivariate analysis (P < 0.0001) with traditional cardiovascular risk factors. Conclusion: Ethnic differences are evident in inflammatory and hemostatic factors, as well as in their associations with CCIMT and PAD. These may reflect differences in cardiovascular risk factors or pathophysiologic processes that characterize each ethnic group.

Elevated Levels of Adhesion Proteins Are Associated With Low Ankle–Brachial Index

“…In particular, in the Framingham Offspring Study, a predominantly white population, soluble P-selectin was not associated with PAD defined using ABI categories or with reported intermittent claudication. 27 Similar results were obtained in a European study conducted by Bennet et al among African Caribbeans and South Asians; 28 of note, significant differences in soluble P-selectin levels were found in this study among the two races/ethnicities. Both studies defined PAD as ABI < 0.9.…”

“…Another possible explanation could be that the power to detect an association was limited by the sample size in previous studies. In fact, the number of PAD cases was 111 in the Framingham Offspring 27 population and only 69 in the study by Bennet et al 28 …”

Influence of ethnic background on left atrial markers of inflammation, endothelial function and tissue remodelling

“…1 , Fig. 2 ) [8] . This disparity suggests that further work is required to accurately determine the contribution of ethnicity to inflammatory and endothelial function responses in cardiovascular disease groups.…”

“…AF incidence, which is associated with an increased risk of stroke have also been shown to differ between ethnicities [7] . Furthermore, ethnic differences in some inflammatory and haemostatic factors have previously been demonstrated [8] .…”

Gait velocity, timed-up-and-go, and timed stair negotiation measurements using body-contact events are accurate and precise for use in patients following vascular surgery

“…Slower self-selected gait velocities exist in those with established disease compared with nondiseased age-matched individuals [1]. Adults with PAD admitted to hospital for surgery are likely to be older and frailer [2,3] increasing the likelihood for significant health care utilisation [4][5][6][7][8][9] and are prone to hospital acquired deconditioning [10]. Secondary cardiovascular dysfunction due to incurred sedentary behaviour may further reduce physical performance and activities of daily living in this population [1,11].…”