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Ethnic differences in cardiovascular risk in rheumatic disease: focus on Asians

Nature Reviews Rheumatology volume 7, pages 609–618 (2011)Cite this article

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Abstract

Rheumatic diseases are associated with high cardiovascular morbidity and mortality. Considerable differences exist in the frequency of cardiovascular disease (CVD) risk factors and events among people of different ethnic origins, but little is known of the ethnic variations in the relative distribution of CVD risk factors and the degree of atherosclerosis in patients with rheumatic diseases. Understanding this variation will provide insight into the underlying pathogenesis of CVD in patients with rheumatic diseases, and aid in future studies of the detection and management of this complication. In general, although Asian patients seem to have fewer background CVD risk factors and are less affected by metabolic syndrome (MetS) than their non-Asian counterparts, those with rheumatic disease are equally as susceptible to CVD. Furthermore, it seems that systemic inflammation and mechanisms that do not involve conventional CVD risk factors and MetS have an important role in the development of atherosclerosis in patients with rheumatic diseases. Here we examine the frequency of conventional CVD risk factors and the prevalence of MetS in both Asian and non-Asian patients with selected rheumatic diseases. We also discuss the burden of CVD, as evaluated using various surrogate markers in these patients, and their overall CVD mortality rate.

Key Points

  • Cardiovascular-related death is more prevalent in non-Asian patients than in Asian patients, in whom death owing to infection is more likely, although direct comparison studies are needed

  • Conventional cardiovascular disease (CVD) risk factors, such as diabetes mellitus, dyslipidemia and hypertension, are similar between patients with or without rheumatic disease

  • The prevalence of metabolic syndrome varies between patients with rheumatic disease of different ethnicity, with Asian patients tending to be less affected than non-Asian patients

  • On the basis of calcium score, carotid intima-media thickness and detection of carotid plaque, Asian patients with rheumatic disease are as susceptible to CVD as their non-Asian counterparts

  • Systemic inflammation has a prominent role in the development of atherosclerosis in Asian patients, despite their low background risk profiles

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Figure 1: Summary of known risk factors for, surrogate markers of, and epidemiology of CVD in Asian and non-Asian populations with RA, SLE or SSc.

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Acknowledgements

The authors thank Tommy Cheung for his help with revising the manuscript.

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  1. Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China

    Kai-Hang Yiu, Hung-Fat Tse, Mo-Yin Mok & Chak-Sing Lau

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All authors made a substantial contribution to discussion of content and to review/editing of the manuscript before submission. K.-H. Yiu & C.-S. Lau contributed equally to researching data for the article and to writing the article.

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Yiu, KH., Tse, HF., Mok, MY. et al. Ethnic differences in cardiovascular risk in rheumatic disease: focus on Asians. Nat Rev Rheumatol 7, 609–618 (2011). https://doi.org/10.1038/nrrheum.2011.126

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