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Canadian Journal of Cardiology

Ethnic Differences in Cardiovascular Disease Risk Factors: A Systematic Review of North American Evidence

  • Danijela Gasevic
    Correspondence
    Corresponding author: Dr Danijela Gasevic, Centre for Population Health Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, United Kingdom. Tel.: +44-(0)131-650-4271.
    Affiliations
    Centre for Population Health Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
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  • Emily S. Ross
    Affiliations
    Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
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  • Scott A. Lear
    Affiliations
    Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada

    Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
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      Abstract

      Background

      Canada is often referred to as a ‘land of immigrants,’ and the high level of immigration has resulted in significant ethnic diversity in Canada.

      Methods

      We performed a systematic review of the literature published from 2000 onward to summarize the evidence on ethnic differences in cardiovascular disease (CVD) risk factors; by comparing the presence of CVD risk factors of Arab, black, Chinese, Hispanic, indigenous, and Filipino ethnic groups with that of CVD risk factors in the white ethnic group.

      Results

      One hundred ten studies met the inclusion criteria for this review. Evidence consistently reported greater prevalence of hypertension in black individuals, greater prevalence of diabetes, overall and abdominal obesity and smoking in indigenous people, greater prevalence of diabetes in Hispanic individuals, and lower prevalence of overall obesity and smoking in Chinese individuals compared with their white counterparts. Although inconsistent, most evidence also indicated higher diastolic blood pressure in black individuals, higher hypertension prevalence in indigenous people, higher prevalence of obesity and diabetes in black individuals, and lower prevalence of smoking in Filipino and Hispanic individuals compared with white individuals. The evidence on ethnic differences in CVD risk factors in Arab, Chinese, and Filipino individuals compared with white individuals is limited.

      Conclusions

      We observed significant ethnic differences in CVD risk factors. However, because most studies were of cross-sectional design and many of them explored the ethnic differences in CVD risk factors without adjustment for potential confounders, more robust designs are needed to get a better insight into where the true differences lie, what factors they are attributed to, and whether they persist or change over time.

      Résumé

      Introduction

      Le Canada est souvent désigné comme une « terre d'immigration », et le niveau élevé de l'immigration a donné lieu à une grande diversité ethnique au Canada.

      Méthodes

      Nous avons effectué une revue systématique de la littérature publiée à partir de l’an 2000 pour résumer les évidences de différences ethniques concernant les facteurs de risque des maladies cardiovasculaires (MCV); en comparant l’existence de facteurs de risque de MCV pour les groupes ethniques arabe, noir, chinois, hispanique, autochtone, et philippin avec celle de facteurs de risque de MCV d’un groupe ethnique blanc.

      Résultats

      Cent dix études répondaient aux critères d'inclusion de cette revue. Les évidences ont constamment rapporté une plus grande prévalence de l'hypertension chez les personnes noires, une plus grande prévalence du diabète, de l’obésité globale et abdominale et du tabagisme chez les populations autochtones, une plus grande prévalence du diabète chez les personnes d'origine hispanique, et une plus faible prévalence de l'obésité globale et du tabagisme chez les individus chinois par rapport à leurs homologues blancs. Bien qu’incompatibles, la plupart des évidences ont également indiqué une pression artérielle diastolique plus élevée chez les personnes noires, une prévalence plus élevée de l'hypertension chez les populations autochtones, une plus forte prévalence de l'obésité et du diabète chez les personnes noires, et une prévalence inférieure du tabagisme chez les individus philippins et hispaniques par rapport aux personnes blanches. La preuve de différences ethniques pour les facteurs de risque de MCV chez les individus arabes, chinois, et philippins par rapport aux personnes blanches reste limitée.

      Conclusions

      Nous avons observé des différences ethniques considérables concernant les facteurs de risque de MCV. Cependant, étant donné que la plupart des études avaient une approche transversale et que beaucoup d'entre elles ont exploré les différences ethniques des facteurs de risque de MCV sans ajustement pour les potentiels facteurs confondants, des approches plus robustes sont nécessaires afin d’avoir une meilleure vision de là où les véritables différences se trouvent, à quels facteurs elles sont attribuées, et si elles persistent ou changent au fil du temps.
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