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 Preventive Cardiology, 20 2: 246-253. doi:10.1177/2047487312437713

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Author Luke, Joanne N.
Brown, Alex D.
Brazionis, Laima
O'Dea, Kerin
Best, James D.
McDermott, Robyn A.
Wang, Zaimin.
Wang, Zhiqiang.
Rowley, Kevin G.
Title Exploring clinical predictors of cardiovascular disease in a central Australian Aboriginal cohort
Journal name European Journal of Preventive Cardiology   Check publisher's open access policy
ISSN 2047-4873
2047-4881
Publication date 2013-04
Year available 2012
Sub-type Article (original research)
DOI 10.1177/2047487312437713
Volume 20
Issue 2
Start page 246
End page 253
Total pages 8
Place of publication London, U.K.
Publisher Sage Publications
Collection year 2013
Language eng
Formatted 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.
Keyword Aboriginal
Indigenous
Risk prediction
Open Access Mandate Compliance No - Author Post-Print Requested
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Formerly the European Journal of Cardiovascular Prevention and Rehabilitation (ISSN: 1350-6277; 1741-8267; 1741-8275).

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2013 Collection
School of Medicine Publications
 
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Created: Wed, 28 Mar 2012, 08:31:43 EST by Zhiqiang Wang on behalf of Medicine - Royal Brisbane and Women's Hospital