Differences in the risk of cardiovascular disease across ethnic groups: UK Biobank observational study.

Background and Aims: To describe sociodemographic, lifestyle, environmental and traditional clinical risk factor differences between ethnic groups and to investigate the extent to which such differences confound the association between ethnic groups and the risk of cardiovascular disease (CVD) METHODS AND RESULTS: A total of 440,693 white European (55.9% women), 7305 South Asian (48.6%) and 7628 black African or Caribbean (57.7%) people were included from UK Biobank. Associations between ethnicity and cardiovascular outcomes (composite of non-fatal stroke, non-fatal myocardial infarction and CVD death) were explored using Cox-proportional hazard models. Models were adjusted for sociodemographic, lifestyle, environmental and clinical risk factors. Over a median (IQR) of 12.6 (11.8, 13.3) follow-up years, there were 22,711 (5.15%) cardiovascular events in white European, 463 (6.34%) in South Asian and 302 (3.96%) in black African or Caribbean individuals. For South Asian people, the cardiovascular hazard ratio (HR) compared to white European people was 1.28 (99% CI [1.16, 1.43]). For black African or Caribbean people, the HR was 0.80 (0.66, 0.97). The elevated risk of CVD in South Asians remained after adjusting for differences in sociodemographic, lifestyle, environmental and clinical factors, whereas the lower risk in black African or Caribbean was largely attenuated.
Conclusions: South Asian, but not black African or Caribbean individuals, have a higher risk of CVD compared to white European individuals. This higher risk in South Asians was independent of sociodemographic, lifestyle, environmental and clinical factors.
Competing Interests: Declaration of competing interest TY, MJD are supported by the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC). KK is Director for the University of Leicester Centre for Ethnic Health Research, Trustee of the South Asian Health Foundation, national NIHR Applied Research Collaborations – East Midlands (ARC-EM) lead for Ethnicity and Diversity and a member of SAGE and Chair of the SAGE subgroup on ethnicity and COVID-19. AH acknowledges funding from the NIHR Health Protection Research Unit in Environmental Exposures and Health Development Award at University of Leicester. Other authors declare no conflicts of interests.
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