Increased carotid intima-media thickness in remote and urban Indigenous Australians: impact of diabetes and components of the metabolic syndrome

Increased carotid intima-media thickness in remote and urban Indigenous Australians: impact of diabetes and components of the metabolic syndrome Journal Article

Clinical Endocrinology

• Author(s): L. Maple-Brown, J. Cunningham, D. S. Celermajer, K. O'Dea
• Published: 2007
• Volume: 66

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Abstract: Summary Objective Indigenous Australians have rates of cardiovascular (CVD) mortality some seven to 10-fold higher than non-Indigenous Australians aged 25–64 years. We aimed to evaluate the impact of type 2 diabetes and components of the metabolic syndrome on carotid intima-media thickness (CIMT) as a marker of cardiovascular risk in Indigenous Australians living in remote and urban environments and in Australians of European ancestry. Design, patients and measurements: CIMT was measured by high-resolution B-mode ultrasound imaging of the common carotid artery in 119 remote Indigenous, 144 urban Indigenous and 122 urban European Australians with and without diabetes. Results: In nondiabetic participants, CIMT was lowest in Europeans (mean (SD) 0·64 mm (0·10)), higher in urban Indigenous Australians (0·67 mm (0·12)) and highest in remote Indigenous Australians (0·73 mm (0·15), P < 0·001). CIMT was higher with diabetes with the same pattern observed between populations: 0·73 mm, 0·79 mm and 0·82 mm, respectively (P < 0·001). Traditional risk factors (age, male gender, blood pressure and HbA1c) explained 35–45% of the variance of CIMT within each population group. However, differences in CIMT between population groups were maintained after adjustment for these cardiovascular risks plus cholesterol and smoking (P < 0·001). Factor analysis revealed that variables of the metabolic syndrome, together with smoking and elevated C-reactive protein (CRP) and urinary albumin-creatinine ratio (ACR), are likely to explain the higher CIMT in Indigenous Australians (and the urban-remote gradient). Unmeasured variables (genetic, psychosocial and socioeconomic) may also contribute to higher CIMT in these populations. Conclusion: Glycaemic control and metabolic syndrome components contribute significantly to premature atherogenesis in Indigenous Australians and we recommend that therapy should be targeted accordingly.

• Urls: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2265.2007.02749.x