Determinants of cardiovascular disease in a multi-ethnic population in adult women aged 18 years and over in South London
Problem
CVD (including coronary heart disease and stroke) is a leading cause of women’s deaths worldwide. In the UK, there are ~3.7 million women living with CVD, and 81,000 deaths annually (~14,000 in women <75 years old) and the risks vary by ethnicity. The aim of this study was to examine the determinants of CVD among an ethnically diverse adult population of women in Lambeth.
Approach
Method: Patient data was collected from 40 practices contributing to Lambeth DataNet in adult women ≥18 years. CVD risk was the main outcome variable and was assessed across six ethnic groups. Confounders which included demographic factors, socio-economic indicators (income quintiles), lifestyle factors, co-morbidities, medications, and access to care variables were adjusted for in the models. Stata 16 was used to run sequential models of logistic regression which were adjusted for practice effects using multi-level modelling.
Findings
Models were stratified by age-group 40-69 and ≥70 years. The fully adjusted model for CVD in women aged 40-69 years showed the following associations: lipid lowering drugs OR 6.6 (p<0.001, 95% CI 5.6-7.7), CVD drugs OR 7.3 (p<0.001, 95% CI 5.3-10.1). The main risk factors for this age-group were smoking OR 1.5 (p<0.001, 95% CI 1.2-1.7), hypertension OR 1.4 (p<0.001), 95% CI 1.3-1.6), and age (years) OR 1.1 (p<0.001, 95% CI 1.0-1.1). Black African ethnicity OR 0.8 (p<0.001, 95% CI 0.7-1.0), diabetes OR 0.8 (p<0.001,95% CI 0.7-1.0) and serious mental illness OR 0.7 (p<0.05, 95% CI 0.5-1.0) were found to be significantly protective. In the fully adjusted model for women aged ≥70 years CVD risk was strongly associated with lipid lowering drugs OR 2.3 (p<0.001, 95% CI 2.0-2.6) and CVD drugs OR 7.2 (p<0.001, 95% CI 4.5-11.6). Hypertension OR 1.4 (p<0.001, 95% CI 1.2-1.6), diabetes OR 1.3 (p<0.001, 95% CI 1.2-1.5) and smoking OR 1.3 (p<0.001, 95% CI 1.1-1.6) were also strongly associated with CVD in this age group. Both Black African ethnicity OR 0.6 (p<0.001, 95%CI 0.5-0.8) and Black Caribbean ethnicity OR 0.8 (p<0.001, 95% CI 0.7-0.9) were found to be protective against CVD.
Consequences
The study suggests important determinants of CVD in ethnically diverse women included age, lifestyle factors such as BMI, smoking, hypertension and diabetes (where effects were divergent by age group). Black African, Black Caribbean ethnicity and serious mental illness showed protective associations with CVD after adjusting for other determinants of CVD including deprivation measures.