Cardiovascular Disease Risk Prediction in Indigenous Australians

Transcription

1 Cardiovascular Disease Risk Prediction in Indigenous Australians ELIZABETH LM BARR (MPH, PHD) NATIONAL HEART FOUNDATION POST-DOC FELLOW Cardiac Care in the NT Annual Workshop 2017 is proudly supported by: MENZIES SCHOOL OF HEALTH RESEARCH

2 Overview Primary prevention of cardiovascular disease (CVD) in Indigenous Australians Limitations of CVD risk scores in Indigenous Australians Cardiovascular Risk in IndigenouS People (CRISP) Study

3 Primary prevention of cardiovascular disease in Indigenous Australians

4 Cardiovascular disease in Indigenous Australians Cardiovascular disease (CVD) remains a major public health problem for Indigenous populations globally including Aboriginal and Torres Strait Islander Australians AIHW 2015

5 Primary prevention of CVD CVD primary prevention largely focuses on management of wellestablished risk factors: smoking, high cholesterol, high blood pressure and diabetes

6 Two potential clinical scenarios for Indigenous Australians Woman 35 years Systolic BP: 135 mmhg uacr: 25 mg/mmol Pre-diabetes Smoker TC: HDL ratio: 4.0 mmol/l Man 43 years Systolic BP: 155 mmhg uacr: 20 mg/mmol Diabetes Non-smoker TC: HDL ratio: 6.0 mmol/l LOW RISK FOR 5 YR CVD?

7 Limitations of CVD risk scores in Indigenous Australians

8 Cardiovascular co-morbidities in Indigenous Australians Proportion of people with CVD, diabetes and chronic kidney disease (AIHW 2015) AIHW data show a much greater overlap of diabetes, kidney disease and CVD for Indigenous Australians Indigenous Australians Non-Indigenous Australians

9 Diabetes and albuminuria strongly linked to the development of CVD Longitudinal studies show strong associations of diabetes and related metabolic factors, and kidney disease with the development of CVD

10 CVD risk associated with traditional risk factors: DRUID follow-up 6.4 ( ) Low HDL Cholesterol Smoking High total cholesterol BP Diabetes Adjusting for age and sex Barr ELM et al. Diabetic Medicine 2017 (in press)

11 CVD risk associated with abnormal glycaemia: DRUID follow-up study 3.3 ( ) 6.4 ( ) 2.7( ) Normal glycaemia Impaired fasting glucose Impaired glucose tolerance Diabetes Adjusted baseline age and sex Barr ELM et al. Diabetic Medicine 2017 (in press)

12 CVD risk associated with other risk factors: DRUID follow-up study Population attributable risk % for CVD in this cohort: - 32% Diabetes - 21% Albuminuria High CRP Dyslipidaemia Macroalb Poor diet Obesity Low income Microalb Adjusted baseline age and sex Barr ELM et al. Diabetic Medicine 2017 (in press)

13 Coronary artery disease incidence underestimated in Indigenous Australians Total cohort Women Men Wang and Hoy. MJA 2015

14 Limitations of individual studies Individual studies have limited generalisability Smaller studies have limited statistical power to assess risk among specific groups (eg. women and men, younger and older people, populations in urban and remote settings) Comparison of study results between studies is limited by different methods and analyses

15 Can we improve current CVD risk scores for Indigenous Australians?

16 Cardiovascular Risk in IndigenouS People (CRISP) Study

17 What is the CRISP study? Individual-level meta-analysis combines participant study data Not aggregate meta-analysis which combines summary study results Create large epidemiological cohort of Indigenous Australians Many advantages! Improves statistical power Consistent and standardize analysis

18 Study cohorts contributing data to CRISP Northern Territory surveys Galiwin ku Healthy Lifestyle Study Bathurst Island Renal Disease Studies (BIRDS) Darwin Region Urban Indigenous Diabetes (DRUID) Study Heart of the Heart Study

19 Study cohorts contributing data to CRISP Studies in Western Australia and Queensland Perth Aboriginal Atherosclerosis Risk Study (PAARS) Well Persons Health Check (WPHC) study ~ 6,000 PARTICIPANTS

20 CRISP aims: Enhance the accuracy of absolute CVD risk assessment for Indigenous Australians To explore the associations of non-traditional risk factors (abdominal obesity, metabolic disorders and albuminuria) compared to traditional risk factors (smoking, cholesterol and blood pressure) to mortality and CVD in Indigenous Australians To identify the profiles of individuals who are at high risk of CVD but currently not identified as being at high risk with existing clinical risk scores To analyse the accuracy of CVD risk scores currently recommended for Indigenous Australians, and where possible, develop an improved CVD risk score

21 CRISP study longitudinal follow-up Baseline surveys and health examinations Cohort Cohort Cohort Cohort Cohort Cohort CVD Hospitalisation Deaths FOLLOW-UP PERIOD 2017 Obtaining CVD outcomes over the period between baseline testing and current follow-up CVD outcomes obtained from state-based hospital databases and the National Death Index

22 CRISP study investigator collaboration Investigators Elizabeth Barr Louise Maple-Brown Alan Cass Joan Cunningham Shawn Tatipata Julie Brimblecombe Robyn McDermott Kerin O Dea Steve Guthridge Christine Connors Wendy Hoy Pamela Bradshaw Peter Thompson Lyn Dimer Alex Brown Jonathan Shaw

23 Summary There is an overwhelming burden of diabetes and albuminuria in CVD risk for Indigenous Australians Current CVD risk scores may not adequately capture future CVD risk in Indigenous Australians CVD risk equations need to be evaluated using Australian data to assess the effects of albuminuria, diabetes and other related factors on CVD risk in Indigenous Australians

24 FUNDING NATIONAL HEART FOUNDATION VANGUARD GRANT NATIONAL HEART FOUNDATION POST-DOCTORAL FELLOWSHIP Thank you PRESENTATION AT THE CARDIAC CARE IN THE NT ANNUAL WORKSHOP DARWIN, JUNE 2017