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Ethnic and regional variation in diabetes among Asian patients with heart failure

Session Poster session 4

Speaker Carolyn Sp Lam

Event : ESC Congress 2016

  • Topic : preventive cardiology
  • Sub-topic : Metabolic Syndrome, Insulin, Insulin Resistance
  • Session type : Poster Session

Authors : T-H K Teng (Singapore,SG), WT Tay (Singapore,SG), J Yap (Singapore,SG), I Anand (Minneapolis,US), W Shimizu (Tokyo,JP), S Zhang S-P Park (Seoul,KR), C Narasimhan (Hyderabad,IN), C-M Yu C-L Hung (Taipei,TW), T Ngarmukos (Bangkok,TH), R Omar (Kuala Lumpur,MY), EB Reyes B Siswanto (Manila,PH), L-H Ling (Singapore,SG), A-M Richards (Singapore,SG), CSP Lam (Singapore,SG)

Authors:
T.-H.K. Teng1 , W.T. Tay2 , J. Yap2 , I. Anand3 , W. Shimizu4 , S. Zhang S-P Park5 , C. Narasimhan6 , C.-M. Yu C-L Hung7 , T. Ngarmukos8 , R. Omar9 , E.B. Reyes B Siswanto10 , L.-H. Ling11 , A.-M. Richards11 , C.S.P. Lam12 , 1National Heart Centre Singapore; School of Population Health, University of Western Australia - Perth - Australia , 2National Heart Centre Singapore - Singapore - Singapore , 3University of Minnesota Medical School, VA Medical Center - Minneapolis - United States of America , 4Nippon Medical School, Department of Cardiovascular Medicine - Tokyo - Japan , 5Korea University, Fu Wai Hospital, Beijing, China; Korea University Hospital - Seoul - Korea Republic of , 6CARE Hospitals - Hyderabad - India , 7Mackay Memorial Hospital, Princess Margaret Hospital, Hong Kong; Mackay Memorial Hospital - Taipei - Taiwan ROC , 8Ramathibodi Hospital of Mahidol University - Bangkok - Thailand , 9National Heart Institute - Kuala Lumpur - Malaysia , 10Manila Doctors Hospital, Manila, Philippines; National Cardiovascular Center Harapan Kita, Univ. of Indonesia, Jakarta, Indonesia - Manila - Philippines , 11National University Health System, Cardiovascular Research Institute, National University of Singapore - Singapore - Singapore , 12National Heart Centre, Duke-NUS Medical School; National University Health System, National University of Singapore - Singapore - Singapore ,

On behalf: ASIAN-HF

Citation:
European Heart Journal ( 2016 ) 37 ( Abstract Supplement ), 736

Background: Asia is one of the most diverse and rapidly developing regions globally, and contains the majority of the world's adult diabetics. Diabetes is a potent cardiovascular risk factor portending heart failure (HF) – a growing epidemic in Asia. Yet little is known regarding ethnic and regional variation in diabetes among patients with HF in Asia.

Aim: To determine the ethnic and regional variation in prevalence of diabetes among Asian patients with HF.

Methods: The prevalence and correlates of diabetes were studied in patients with HF and LVEF ≤40% from 46 centres in 11 Asian regions of the prospective ASIAN-HF Registry. WHO criteria were used to classify the stage of economic development (Lower income– Indonesia, India, Philippines; Middle income – China, Thailand and Malaysia; Higher income– Singapore, Hong Kong, Taiwan, South Korea and Japan). Ethnic groups comprised Chinese (29.9%), Indian (31.6%), Malay (15.3%), Japanese (10.1%), Korean (6.0%), Thai (3.2%), Indigenous SE Asians (2.5%). Multivariable analyses were used to examine the association of predictors with diabetes.

Results: Among a total of 5,231 patients with HF (mean age 59.6±13.1 years, 78% men), diabetes was present in 41%. The prevalence ranged from 58% in Hong Kong and Singapore, 49% in Malaysia and 45% in Taiwan, 37% in India, 34% in Indonesia and Thailand, 32% in Japan and 30% in Korea, 27% in the Philippines and 23% in China. Higher (vs lower) income was strongly associated with diabetes, with an adjusted odds ratio (OR) higher (3.1, 95% CI 2.3–4.1) than that of other traditional risk factors such as hypertension (OR=2.4, 95% CI 2.1–2.8) and obesity (OR=1.5, 95% CI 1.3–1.9). Compared to Chinese, Indians (OR=3.1, 95% CI 2.3–4.2) and Malays (OR=2.0, 95% CI 1.5–2.5) had higher odds, whereas Koreans and Japanese had lower odds (OR=0.70), of diabetes. Compared to Chinese from mainland China, Chinese from Hong Kong, Singapore and Malaysia had 2–3 fold higher odds of diabetes. Compared to Malays from Indonesia, Malays from Malaysia and Singapore had 1.8–2.5 fold higher odds of diabetes. Compared to Indians from India, Indians from Malaysia and Singapore had 3-fold odds of diabetes (all p<0.05).

Conclusions: There is marked heterogeneity in the prevalence of diabetes among Asian patients with heart failure. Both ethnicity and regional income level are independent risk factors which prominently interact to produce exceptionally high rates of diabetes among Chinese, Malays and Indians from higher income regions. These results carry important public health implications for Asia.

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