• Masaya Koshizaka, Renato D Lopes, L Kristin Newby, Robert M Clare, Phillip J Schulte, Pierluigi Tricoci, Kenneth W Mahaffey, Hisao Ogawa, David J Moliterno, Robert P Giugliano, Kurt Huber, Stefan James, Robert A Harrington, and John H Alexander.
• Duke Clinical Research Institute, Duke University Medical Center, Durham, NC; Division of Diabetes, Metabolism and Endocrinology, Clinical Research Center, Chiba University Hospital, Japan. Electronic address: overslope@chiba-u.jp.
• Am. J. Med. 2017 Oct 1; 130 (10): 117011761170-1176.

BackgroundMost diabetes and cardiovascular studies have been conducted in white patients, with data being extrapolated to other population groups.MethodsFor this analysis, patient-level data were extracted from 5 randomized clinical trials in patients with acute coronary syndrome; we compared obesity levels between Asian and white populations, stratified by diabetes status. By using an adjusted Cox proportional hazards model, hazard ratios (HRs) for cardiovascular outcomes after an acute coronary syndrome were determined.ResultsWe identified 49,224 patient records from the 5 trials, with 3176 Asians and 46,048 whites. Whites with diabetes had higher body mass index values than those without diabetes (median 29.3 vs 27.2 kg/m2; P < .0001), whereas Asians with diabetes and without diabetes had similar body mass index (24.7 vs 24.2 kg/m2). Asians with diabetes (HR, 1.63; 95% confidence interval [CI], 1.32-2.02), whites with diabetes (HR, 1.15; 95% CI, 1.06-1.25), and Asians without diabetes (HR, 1.36; 95% CI, 1.14-1.64) had higher rates of the composite of death, myocardial infarction, or stroke at 30 days than whites without diabetes. Asians with diabetes (HR, 1.84; 95% CI, 1.47-2.31), whites with diabetes (HR, 1.47; 95% CI, 1.33-1.62), and Asians without diabetes (HR, 1.38; 95% CI, 1.11-1.73) had higher rates of death at 1 year compared with whites without diabetes. There were no significant interactions between race and diabetes for ischemic outcomes.ConclusionsAlthough Asians with diabetes and acute coronary syndrome are less likely to be obese than their white counterparts, their risk for death or recurrent ischemic events was not lower.Copyright © 2017 Elsevier Inc. All rights reserved.

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