Exploring clinical predictors of cardiovascular disease in a central Australian Aboriginal cohort

Luke, Joanne N., Brown, Alex D., Brazionis, Laima, O'Dea, Kerin, Best, James D., McDermott, Robyn A., Wang, Zaimin, Wang, Zhiqiang, and Rowley, Kevin G. (2013) Exploring clinical predictors of cardiovascular disease in a central Australian Aboriginal cohort. European Journal of Preventative Cardiology, 20 (2). pp. 246-253.

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Abstract

Introduction: For Aboriginal populations, predicting individuals at risk of cardiovascular disease (CVD) is difficult due to limitations and inaccuracy in existing risk-prediction algorithms. We examined conventional and novel risk factors associated with insulin resistance and the metabolic syndrome and assessed their relationships with subsequent CVD events.

Design: Longitudinal cohort.

Methods: Aboriginal people (n = 739) from Central Australia completed population-based risk-factor surveys in 1995 and were followed up in 2005. Principal components analysis (PCA), regression and univariate analyses (using ROC defined cut-off points) were used to identify useful clinical predictors of primary CVD.

Results: PCA yielded five components: (1) lipids and liver function; (2) insulin resistance; (3) blood pressure and kidney function; (4) glucose tolerance; and (5) anti-inflammatory (low fibrinogen, high HDL cholesterol). Components 2, 3 and 4, and age were significant independent predictors of incident CVD, and smoking approached significance. In univariate analysis fasting glucose >= 4.8 mmol/l, total: HDL cholesterol ratio >= 5.7, non-HDL cholesterol >= 4.3 mmol/l, gamma-glutamyl transferase >= 70 U/l, albumin creatinine ratio >= 5.7 mg/mmol, systolic blood pressure >= 120 mmHg and diastolic blood pressure >= 70 mmHg were useful predictors of CVD. The co-occurrence of three or more risk variables (fasting glucose >= 4.8 mmol/l, total: HDL cholesterol ratio >= 5.7, blood pressure (systolic >= 120 mmHg; diastolic >= 70 mmHg; albumin: creatinine ratio >= 5.7 mg/mmol and smoking) had sensitivity of 82.0% and specificity of 59.9% for predicting incident CVD.

Conclusion: Age is the strongest predictor of CVD for this population. For clinical identification of individuals at high risk, screening for the combination of three or more of hyperglycaemia, dyslipidaemia, hypertension, albuminuria and smoking may prove a useful and efficient strategy.

Item ID: 35777
Item Type: Article (Refereed Research - C1)
Keywords: Aboriginal, Indigenous, risk prediction
ISSN: 2047-4881
Funders: National Health and Medical Research Council of Australia (NHMRC), National Heart Foundation of Australia (NHF)
Projects and Grants: NHMRC HOMELANDS Program grant #299852, NHMRC project grant #974302
Date Deposited: 15 Oct 2014 16:48
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111701 Aboriginal and Torres Strait Islander Health @ 100%
SEO Codes: 92 HEALTH > 9203 Indigenous Health > 920301 Aboriginal and Torres Strait Islander Health - Determinants of Health @ 100%
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