Open Access

Crystel M. Gijsberts, Karlijn A. Groenewegen, Imo E. Hoefer, Marinus J. C. Eijkemans, Folkert W. Asselbergs, Todd J. Anderson, Annie R. Britton, Jacqueline M. Dekker, Gunnar Engström, Greg W. Evans, Jacqueline de Graaf, Diederick E. Grobbee, Bo Hedblad, Suzanne Holewijn, Ai Ikeda, Kazuo Kitagawa, Akihiko Kitamura, Dominique P. V. de Kleijn, Eva M. Lonn, Matthias Lorenz, Ellisiv B. Mathiesen, Giel Nijpels, Shuhei Okazaki, Daniel H. O'Leary, Gerard Pasterkamp, Sanne A. E. Peters, Joseph F. Polak, Jacqueline F. Price, Christine Robertson, Christopher M. Rembold, Maria Rosvall, Tatjana Rundek, Jukka T. Salonen, Matthias Sitzer, Coen D. A. Stehouwer, Michiel L. Bots, Hester M. den Ruijter

• Background: Clinical manifestations and outcomes of atherosclerotic disease differ between ethnic groups. In addition, the prevalence of risk factors is substantially different. Primary prevention programs are based on data derived from almost exclusively White people. We investigated how race/ethnic differences modify the associations of established risk factors with atherosclerosis and cardiovascular events. Methods: We used data from an ongoing individual participant meta-analysis involving 17 population-based cohorts worldwide. We selected 60,211 participants without cardiovascular disease at baseline with available data on ethnicity (White, Black, Asian or Hispanic). We generated a multivariable linear regression model containing risk factors and ethnicity predicting mean common carotid intima-media thickness (CIMT) and a multivariable Cox regression model predicting myocardial infarction or stroke. For each risk factor we assessed how the association with the preclinical and clinical measures of cardiovascular atherosclerotic disease was affected by ethnicity. Results: Ethnicity appeared to significantly modify the associations between risk factors and CIMT and cardiovascular events. The association between age and CIMT was weaker in Blacks and Hispanics. Systolic blood pressure associated more strongly with CIMT in Asians. HDL cholesterol and smoking associated less with CIMT in Blacks. Furthermore, the association of age and total cholesterol levels with the occurrence of cardiovascular events differed between Blacks and Whites. Conclusion: The magnitude of associations between risk factors and the presence of atherosclerotic disease differs between race/ethnic groups. These subtle, yet significant differences provide insight in the etiology of cardiovascular disease among race/ethnic groups. These insights aid the race/ethnic-specific implementation of primary prevention.