Subclinical coronary atherosclerosis in asymptomatic Filipino and white women

Abstract

Background - Coronary heart disease (CHD) is the leading cause of morbidity and mortality in persons with type 2 diabetes mellitus (T2DM), Electron-beam computed tomography (EBCT) detects coronary artery calcium (CAC), a marker of atherosclerotic plaque. Few studies have described EBCT-defined CHD among ethnic minorities with elevated T2DM prevalence. The objective of this study was to compare EBCT-defined CAC in Filipino and white women without known cardiovascular disease. Methods and Results - Subjects were participants aged 55 to 78 years in the Rancho Bernardo Study (n=196) and the University of California at San Diego's Filipino Women's Health Study (n=181). Glucose, blood pressure, lipids, anthropometric measurements, and lifestyle factors were measured from 1995 to 1999. EBCT-defined CAC scores, visceral and subcutaneous fat, and statin use were assessed in 2001 to 2002. Compared with whites, Filipinas had a significantly higher prevalence of T2DM (32.6% versus 6.1%, P<0.001) and the metabolic syndrome (32.6% versus 13.8, P<0.001). Filipinas were younger (64.4 versus 66.7 years), had higher triglyceride levels (155 versus 135 mg/dL), had a higher ratio of total cholesterol to HDL cholesterol (4.3 versus 3.5), more frequently used statins (31% versus 19%), and had more visceral fat (69.4 versus 62.1 cm3) and lower HDL cholesterol levels (54 versus 66 mg/dL) than whites. Exercise frequency, body mass index, and waist girth did not differ by ethnicity. Nevertheless, extensive (CAC score ≥400; 9% versus 9%) and moderate (CAC score 150 to 399; 13% versus 11%) atherosclerotic plaque did not differ by ethnicity, even after adjustment for age, T2DM, hypertension, estrogen use, statin use, smoking, lipids, and visceral fat. Conclusions - Filipinas had no excess of subclinical atherosclerosis despite their significantly higher prevalence of T2DM, the metabolic syndrome, hypertension, and visceral adiposity.