Ethnic differences in risk factors and total risk of cardiovascular disease based on the Norwegian CONOR study

Abstract

Background:

Risk of cardiovascular disease varies between ethnic groups and the aim of this study was to investigate differences in cardiovascular risk factors, and total cardiovascular risk between ethnic groups in Norway.

Design:

Cross-sectional study using data from the Cohort of Norway (CONOR).

Methods:

A sample of 62,145 participants, 40–65 years of age, originating from 11 geographical regions, were included in our study. Self-reported variables, blood samples and physical measurements were used to estimate age- and time-adjusted mean values of cardiovascular risk factors for different ethnic groups. The 10-year risks of cardiovascular mortality and cardiovascular events were calculated using the Framingham and NORRISK risk models.

Results:

We observed differences between ethnic groups for cardiovascular risk factors and both Framingham and NORRISK risk scores. NORRISK showed significant differences by ethnicity in women only. Immigrants from the Indian subcontinent had the lowest high-density lipoprotein (HDL) levels, the highest levels of blood glucose, triglycerides, total cholesterol/HDL ratio, waist hip ratio and diabetes prevalence. Immigrants from the former Yugoslavia had the highest Framingham scores, high blood pressure, high total cholesterol/HDL ratio, overweight measures and smoking. Low cardiovascular risk was observed among East Asian immigrants.

Conclusion:

The previously reported excess cardiovascular risk among immigrants from the Indian subcontinent was supported in this study. We also showed that immigrants from the former Yugoslavian countries had a higher total 10-year risk of cardiovascular events than other ethnic groups. This study adds information about ethnic groups in Norway which needs to be addressed in further research and targeted prevention strategies.

Keywords

Cardiovascular disease risk factors ethnic groups lipids blood pressure blood glucose Cohort of Norway

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References

World Health Organization. Prevention of cardiovascular disease: guidelines for assessment and management of cardiovascular risk. Geneva: World Health Organization, 2007.

Yusuf

Reddy

Ounpuu

. Global burden of cardiovascular diseases: part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation 2001; 104: 2746–2753.

Statistics Norway. Causes of deaths, 2010. Difference in gender for ischemic heart disease, http://www.ssb.no/en/dodsarsak/ (accessed 24 May 2012).

Norheim OF, Gjelsvik B, Kjeldsen SE, et al. Nasjonale retningslinjer for individuell primærforebygging av hjerte- og karsykdommer. Oslo: Norwegian Directorate of Health. 2009; IS–1550.

Chaturvedi

. Ethnic differences in cardiovascular disease. Heart 2003; 89: 681–686.

Forouhi

Sattar

. CVD risk factors and ethnicity.. A homogeneous relationship? Atheroscler Suppl 2006; 7: 11–19.

Kurian

Cardarelli

. Racial and ethnic differences in cardiovascular disease risk factors: a systematic review. Ethn Dis 2007; 17: 143–152.

Balarajan

. Ethnic differences in mortality from ischaemic heart disease and cerebrovascular disease in England and Wales. BMJ 1991; 302: 560–564.

Chaturvedi

McKeigue

Marmot

. Resting and ambulatory blood pressure differences in Afro-Caribbeans and Europeans. Hypertension 1993; 22: 90–96.

10.

Glenday

Kumar

Tverdal

. Cardiovascular disease risk factors among five major ethnic groups in Oslo, Norway: the Oslo Immigrant Health Study. Eur J Cardiovasc Prev Rehabil 2006; 13: 348–355.

11.

Kumar

Selmer

Lindman

. Ethnic differences in SCORE cardiovascular risk in Oslo, Norway. Eur J Cardiovasc Prev Rehabil 2009; 16: 229–234.

12.

D'Agostino

Sr Vasan

Pencina

. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation 2008; 117: 743–753.

13.

Selmer

Lindman

Tverdal

. Modell for estimering av kardiovaskulær risiko i Norge. Tidsskr Nor Legeforen 2008; 128: 286–290.

14.

Næss

Søgaard

Arnesen

. Cohort profile: Cohort of Norway (CONOR). Int J Epidemiol 2008; 37: 481–485.

15.

Bhopal

. Glossary of terms relating to ethnicity and race: for reflection and debate. J Epidemiol Community Health 2004; 58: 441–445.

16.

O'Keefe

Gheewala

O'Keefe

. Dietary strategies for improving post-prandial glucose, lipids, inflammation, and cardiovascular health. J Am Coll Cardiol 2008; 51: 249–255.

17.

Anderson

Odell

Wilson

PWF

. Cardiovascular disease risk profiles. Am Heart J 1991; 121: 293–298.

18.

Graham

Atar

Borch-Johnsen

. European guidelines on cardiovascular disease prevention in clinical practice: executive summary. Eur Heart J 2007; 28: 2375–2414.

19.

Lindman

Veierød

Pedersen

. The ability of the SCORE high-risk model to predict 10-year cardiovascular disease mortality in Norway. Eur J Cardiovasc Prev Rehabil 2007; 14: 501–507.

20.

Søgaard

Gustad

Bjertness

. Urban-rural differences in distal forearm fractures: Cohort Norway. Osteoporos Int 2007; 18: 1063–1072.

21.

Zomer

Owen

Magliano

. Validation of two Framingham cardiovascular risk prediction algorithms in an Australian population: the ‘old’ versus the ‘new’ Framingham equation. Eur J Cardiovasc Prev Rehabil 2011; 18: 115–120.

22.

Yusuf

Reddy

Ounpuu

Anand

. Global burden of cardiovascular diseases: part II: variations in cardiovascular disease by specific ethnic groups and geographic regions and prevention strategies. Circulation 2001; 104: 2855–2864.

23.

Mokdad

Bowman

Ford

. The continuing epidemics of obesity and diabetes in the United States. JAMA 2001; 286: 1195–1200.

24.

Katzmarzyk

Mason

. Prevalence of class I, II and III obesity in Canada. CMAJ 2006; 174: 156–157.

25.

. Test of the ‘healthy migrant hypothesis': a longitudinal analysis of health selectivity of internal migration in Indonesia. Soc Sci Med 2008; 67: 1331–1339.

26.

Braveman

Egerter

Mockenhaupt

. Broadening the focus: the need to address the social determinants of health. Am J Prev Med 2011; 40: S4–S18.

27.

Patel

Vyas

Cruickshank

. Impact of migration on coronary heart disease risk factors: Comparison of Gujaratis in Britain and their contemporaries in villages of origin in India. Atherosclerosis 2006; 185: 297–306.

28.

Jafar

. The growing burden of chronic kidney disease in Pakistan. New Engl J Med 2006; 354: 995–997.

29.

Hales

Barker

DJP

. The thrifty phenotype hypothesis. Br Med Bull 2001; 60: 5–20.

30.

Yajnik

. The insulin resistance epidemic in india: fetal origins, later lifestyle, or both? Nutr Rev 2001; 59: 1–9.

31.

Goyal

Yusuf

. The burden of cardiovascular disease in the Indian subcontinent. Indian J Med Res 2006; 124: 235–244.

32.

Grossmann FF, Leventhal ME, Auer-Böer B, et al. Self-Reported cardiovascular risk factors in immigrants and Swiss nationals. Public Health Nurs 2011; 28: 129–139.

33.

Kruseman

Stoll

Stalder

. Interactive group education for refugees from the Former Yugoslavia to reduce their oil consumption. Patient Educ Couns 2003; 49: 171–176.

34.

Markovic

Manderson

Kelaher

. The health of immigrant women: Queensland women from the former Yugoslavia. J Immigr Health 2002; 4: 5–15.

35.

Van den Heuvel

WJA

. Health status of refugees from former Yugoslavia: descriptive study of the refugees in the Netherlands. Croat Med J 1998; 39: 356–360.

36.

Boscarino

Chang

. Electrocardiogram abnormalities among men with stress-related psychiatric disorders: implications for coronary heart disease and clinical research. Ann Behav Med 1999; 21: 227–234.

37.

Bhopal

Unwin

White

. Heterogeneity of coronary heart disease risk factors in Indian, Pakistani, Bangladeshi, and European origin populations: cross sectional study. BMJ 1999; 319: 215–220.

38.

Stronks

Kulu-Glasgow

Agyemang

. The utility of ‘country of birth’ for the classification of ethnic groups in health research: the Dutch experience. Ethn Health 2009; 14: 255–269.