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SUNSET  “differences in cardiovascular risk factors between three ethnic groups in the Netherlands”
Background ,[object Object],[object Object]
Objectives ,[object Object],[object Object]
SUNSET Design ,[object Object],[object Object],[object Object]
 
Characteristics 37,7% 30,2% 32,2% physical activity  (prevention norm NHS) 91,8  [90,5-93,0] 93,6  [92,4-94,7] 94,1  [92,7-95,5] waist circ.  [95% CI] 26,2  [25,7-26-6] 28,5  [28,0-28,9] 27,0  [26,4-27,6] BMI  [95% CI] 9,2% 25,7% 26,5% lowest income level 37,9% 18,9% 9,3% highest education level 255  (50%) 394  (67%) 159  (54%) sex: female 47,6  (6,8) 44,5  (6,6) 43,6  (6,0) mean age (year) white Dutch blacks South Asians
Prevalence of CVD  (35-60 years)   (Rose questionnaire: AP, MI, CVA, CI)
Prevalence of MS  (NCEP ATP III definition)  5.2  5.2 6.9 Fasting glucose ≥ 110 mg/dl (6.1 mmol/l) 36.7 46.6 45.1 blood pressure ≥ 130/ ≥ 85 mm Hg 18.2 25.3 42.8 HDL cholesterol < 40 mg/dl (1.03 mmol/l) in men  and < 50 mg/dl (1.29 mmol/l) in women 23.1 10.4  26.8 triglycerides ≥ 150 mg/dl (1.7 mmol/l) 32.9 49.4  48.1  central obesity, waist circumference > 102 cm in men and > 88 cm in women three or more of the following five risk factors: 23.1 10.4 27.1  NCEP criteria for metabolic syndrome white Europeans Creoles Hindustani
NCEP Metabolic Syndrome ,[object Object],[object Object],[object Object],[object Object],[object Object]
Prevalence of MS  (IDF definition)  Hindustani   Creoles   white Europeans 27.8 34.4 51.3  Raised fasting plasma glucose ≥ 100 mg/dl (5.6 mmol/l), or previously diagnosed type 2 diabetes 38.6 49.6 50.1 Raised blood pressure  ≥ 130/ ≥ 85 mm Hg, or treatment of previously diagnosed hypertension 21.2 25.3 42.8 Reduced HDL cholesterol < 40 mg/dl (1.03 mmol/l)  in men and < 50 mg/dl (1.29 mmol/l) in women,  or specific treatment for this lipid abnormality 25.1 10.4 26.8 Raised triglycerides ≥ 150 mg/dl (1.7 mmol/l),  or specific treatment for this lipid abnormality plus any two of the following four factors: 59.5 67.6 77.8 central obesity, waist circumference ≥ 94 cm in men and ≥ 80 cm in woman, with ethnic specific value for South Asian men ≥ 90 cm 27.6 28.4 48.7 IDF criteria for metabolic syndrome
Table 3. Odds ratios for prevalent CVD.  Data are odds ratios with [95% CI]. CVD = cardiovascular disease, OR = odds ratio, MS = metabolic syndrome,  NCEP = National Cholesterol Education Programme, IDF = International Diabetes Federation. 1 0.9 [0.6-1.3] 1.0 [0.8-1.4] 1.5 [1.1-2.1] 1.9 [1.5-2.6] MS no MS sex, age, smoking,  MS (IDF definition) ,  and interaction:  MS*ethnicity 1 2.0 [1.2-3.5] 4.0 [2.4-6.9] all sex, age, smoking  and  MS (NCEP definition) 1 2.0 [1.2-3.5] 4.3 [2.5-7.3] all sex, age and smoking 1 2.0 [1.2-3.4] 4.1 [2.4-6.9] all sex and age  white Europeans  (n = 490) OR [95% CI] blacks  (n = 605) OR [95% CI] South Asians  (n = 339) OR [95% CI] subcategory of  subjects Adjusted for:
Conclusions (1) ,[object Object],[object Object],[object Object],[object Object],[object Object]
Prevalence of DM   (45-60 years)    (fasting glucose level  ≥  7.0 or on drug treatment)
Prevalence of DM  (35-44 years)   (fasting glucose level  ≥  7.0 or on drug treatment)
Table 2 . Risk factors for DM  a 1 1 37.5 17.0 white Europeans 1.7 [1.1-2.6] 2.2 [1.5-3.2] 42.3 41.7 blacks 3.2 [2.0-5.2] 4.5 [3.0-6.7] 20.3 41.3 South Asians ethnic group :  2.5 [1.2-5.0] 5.2 [2.9-9.4] 2.1 10.0 history of cardiovascular disease 2.3 [1.6-3.2] 3.9 [2.9-5.2] 29.1 61.4 hypertension  e 2.7 [1.8-4.0] 3.7 [2.6-5.3] 55.9 82.5 first-degree relative with DM  d 2.2 [1.4-3.5] 2.9 [2.0-4.4] 7.5 19.1 resting heart rate ≥ 90 bpm 2.3 [1.3-4.0] 4.9 [3.1-7.7] 63.4 89.4 increased waist circumference  c 1.6 [1.0-2.6] 3.4 [2.3-4.9] 59.4 83.2 BMI > 25  1.8 [1.2-2.5] 2.0 [1.51-2.7] 48.9 66.1 age  ≥ 45 year multivariate b   OR [95% CI] univariate  OR [95% CI] no DM (n=1204) DM (n=230) risk of DM prevalence of determinant (%) risk factor
Prevalence high BP (women) (BP > or = 140/90 mm Hg or on drug treatment)
Prevalence high BP (men)  (BP > or = 140/90 mm Hg or on drug treatment)
Treatment of HT (women)
Treatment of HT (men)
Adequate treatment of HT ,[object Object],[object Object],[object Object],[object Object],0,4* [0,2-0,7] Creoles women 0,5 [0,2-1,1] Hindustani 0,9 [0,4-2,3] 0,3* [0,1-0,7] Adequately treated (among hypertensives) Hindustani Creoles men OR [95% CI]
Conclusions (2) ,[object Object],[object Object],[object Object],[object Object],[object Object]
DISCUSSION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hart – en vaatziekten in Hindoestanen ,[object Object],[object Object],[object Object],[object Object]
Pathofysiologie Metabool Metabool Vasculair
Pathofysiologie HVZ Hindoestanen - metabool ,[object Object],[object Object],[object Object],[object Object],[object Object]
Komt adipose tissue dysfunction vaker voor in Hindoestanen? ,[object Object]
 
 
 
 
 
 
Wit vet en Hindoestanen ,[object Object],[object Object],[object Object],[object Object]
Wat is de vetopslag capaciteit van Hindoestanen? ,[object Object],[object Object],[object Object],[object Object],[object Object]

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Hindoestanen

  • 1. SUNSET “differences in cardiovascular risk factors between three ethnic groups in the Netherlands”
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  • 6. Characteristics 37,7% 30,2% 32,2% physical activity (prevention norm NHS) 91,8 [90,5-93,0] 93,6 [92,4-94,7] 94,1 [92,7-95,5] waist circ. [95% CI] 26,2 [25,7-26-6] 28,5 [28,0-28,9] 27,0 [26,4-27,6] BMI [95% CI] 9,2% 25,7% 26,5% lowest income level 37,9% 18,9% 9,3% highest education level 255 (50%) 394 (67%) 159 (54%) sex: female 47,6 (6,8) 44,5 (6,6) 43,6 (6,0) mean age (year) white Dutch blacks South Asians
  • 7. Prevalence of CVD (35-60 years) (Rose questionnaire: AP, MI, CVA, CI)
  • 8. Prevalence of MS (NCEP ATP III definition) 5.2 5.2 6.9 Fasting glucose ≥ 110 mg/dl (6.1 mmol/l) 36.7 46.6 45.1 blood pressure ≥ 130/ ≥ 85 mm Hg 18.2 25.3 42.8 HDL cholesterol < 40 mg/dl (1.03 mmol/l) in men and < 50 mg/dl (1.29 mmol/l) in women 23.1 10.4 26.8 triglycerides ≥ 150 mg/dl (1.7 mmol/l) 32.9 49.4 48.1 central obesity, waist circumference > 102 cm in men and > 88 cm in women three or more of the following five risk factors: 23.1 10.4 27.1 NCEP criteria for metabolic syndrome white Europeans Creoles Hindustani
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  • 10. Prevalence of MS (IDF definition) Hindustani Creoles white Europeans 27.8 34.4 51.3 Raised fasting plasma glucose ≥ 100 mg/dl (5.6 mmol/l), or previously diagnosed type 2 diabetes 38.6 49.6 50.1 Raised blood pressure ≥ 130/ ≥ 85 mm Hg, or treatment of previously diagnosed hypertension 21.2 25.3 42.8 Reduced HDL cholesterol < 40 mg/dl (1.03 mmol/l) in men and < 50 mg/dl (1.29 mmol/l) in women, or specific treatment for this lipid abnormality 25.1 10.4 26.8 Raised triglycerides ≥ 150 mg/dl (1.7 mmol/l), or specific treatment for this lipid abnormality plus any two of the following four factors: 59.5 67.6 77.8 central obesity, waist circumference ≥ 94 cm in men and ≥ 80 cm in woman, with ethnic specific value for South Asian men ≥ 90 cm 27.6 28.4 48.7 IDF criteria for metabolic syndrome
  • 11. Table 3. Odds ratios for prevalent CVD. Data are odds ratios with [95% CI]. CVD = cardiovascular disease, OR = odds ratio, MS = metabolic syndrome, NCEP = National Cholesterol Education Programme, IDF = International Diabetes Federation. 1 0.9 [0.6-1.3] 1.0 [0.8-1.4] 1.5 [1.1-2.1] 1.9 [1.5-2.6] MS no MS sex, age, smoking, MS (IDF definition) , and interaction: MS*ethnicity 1 2.0 [1.2-3.5] 4.0 [2.4-6.9] all sex, age, smoking and MS (NCEP definition) 1 2.0 [1.2-3.5] 4.3 [2.5-7.3] all sex, age and smoking 1 2.0 [1.2-3.4] 4.1 [2.4-6.9] all sex and age white Europeans (n = 490) OR [95% CI] blacks (n = 605) OR [95% CI] South Asians (n = 339) OR [95% CI] subcategory of subjects Adjusted for:
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  • 13. Prevalence of DM (45-60 years) (fasting glucose level ≥ 7.0 or on drug treatment)
  • 14. Prevalence of DM (35-44 years) (fasting glucose level ≥ 7.0 or on drug treatment)
  • 15. Table 2 . Risk factors for DM a 1 1 37.5 17.0 white Europeans 1.7 [1.1-2.6] 2.2 [1.5-3.2] 42.3 41.7 blacks 3.2 [2.0-5.2] 4.5 [3.0-6.7] 20.3 41.3 South Asians ethnic group : 2.5 [1.2-5.0] 5.2 [2.9-9.4] 2.1 10.0 history of cardiovascular disease 2.3 [1.6-3.2] 3.9 [2.9-5.2] 29.1 61.4 hypertension e 2.7 [1.8-4.0] 3.7 [2.6-5.3] 55.9 82.5 first-degree relative with DM d 2.2 [1.4-3.5] 2.9 [2.0-4.4] 7.5 19.1 resting heart rate ≥ 90 bpm 2.3 [1.3-4.0] 4.9 [3.1-7.7] 63.4 89.4 increased waist circumference c 1.6 [1.0-2.6] 3.4 [2.3-4.9] 59.4 83.2 BMI > 25 1.8 [1.2-2.5] 2.0 [1.51-2.7] 48.9 66.1 age ≥ 45 year multivariate b OR [95% CI] univariate OR [95% CI] no DM (n=1204) DM (n=230) risk of DM prevalence of determinant (%) risk factor
  • 16. Prevalence high BP (women) (BP > or = 140/90 mm Hg or on drug treatment)
  • 17. Prevalence high BP (men) (BP > or = 140/90 mm Hg or on drug treatment)
  • 18. Treatment of HT (women)
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Notes de l'éditeur

  1. I am very pleased to here present the first results of our SUNSET study. The SUNSET study is a study on cardiovascular risk factors between two ethnic subgroups from Surinam. Surinam is a former colony of The Netherlands in South Amercia.
  2. Surinamese migrants more frequently die from cardiovascular disease than native Dutch. In a city like Amsterdam about 60% of the newborn are of a different ethnicity than Dutch. To ensure good health care for all residents of Amsterdam, information is needed on the prevalence of cardiovascular risk factors that might explain the excess mortality among Surinamese. We also need more information on the determinants of the risk factors in these groups to see whether interventions developed for native Dutch should be adapted to the Surinamese.
  3. A main objective of sunset is to explain the excess mortality from CVD in surinamese. We both collected data on the prevalence of risk factors and on determinants that might explain the increased prevalence of these risk factors. In this progress report I will focus on the determinants of hbp
  4. In Amsterdam, there are more Creole women than men, so it is not that more Creole men than Hindu and Dutch men refused to participate.
  5. This slide shows the prevalences of diabetes in the three ethnic groups &lt; 45
  6. This slide shows the prevalences of diabetes in the three ethnic groups &gt; or = 45
  7. This slide shows the prevalences of diabetes in the three ethnic groups &lt; 45
  8. A main objective of sunset is to explain the excess mortality from CVD in surinamese. We both collected data on the prevalence of risk factors and on determinants that might explain the increased prevalence of these risk factors. In this progress report I will focus on the determinants of hbp
  9. This slide shows the prevalences of high blood pressure in the three ethnic groups in women
  10. This slide shows the prevalences of high blood pressure in the three ethnic groups in men
  11. To finish, …