Racial/Ethnic Differences in Subclinical Atherosclerosis Among Adults With Diabetes
The Multiethnic Study of Atherosclerosis
- Mercedes R. Carnethon, PHD1,
- Alain G. Bertoni, MD, MPH2,
- Steven Shea, MD34,
- Philip Greenland, MD1,
- Hanyu Ni, PHD5,
- David R. Jacobs, Jr, PHD67,
- Mohammed Saad, MD8 and
- Kiang Liu, PHD1
- 1Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- 2Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- 3Department of Epidemiology Mailman School of Public Health, Columbia University, New York, New York
- 4Department of General Medicine, Columbia University Medical Center, Columbia University, New York, New York
- 5National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
- 6Division of Epidemiology, University of Minnesota School of Public Health, Minneapolis, Minnesota
- 7Department of Nutrition, University of Oslo, Oslo, Norway
- 8Division of Endocrinology, University of California, Los Angeles, California
- Address correspondence and reprint requests to Mercedes R. Carnethon, Department of Preventive Medicine, 680 N. Lake Shore Dr., Suite 1102, Chicago, IL 60611. E-mail:carnethon{at}northwestern.edu
- ABI, ankle brachial index
- CAC, coronary artery calcium
- CVD, cardiovascular disease
- IMT, intimal medial thickness
- MESA, Multiethnic Study of Atherosclerosis
- PAD, peripheral artery disease
Recent findings from the Multi-ethnic Study of Atherosclerosis (MESA) (1) are consistent with previous reports that non-Hispanic white (white) adults have a greater presence and quantity of coronary artery calcium (CAC) than non-Hispanic black (black), Hispanic, and Chinese-American (Chinese) adults (2,3,4,5). It is not known whether previously reported racial/ethnic differences in atherosclerosis persist in the presence of type 1 or type 2 diabetes, an established risk factor for cardiovascular disease (CVD). Further, it is not known whether previously reported racial/ethnic differences in markers of atherosclerosis in the carotid and peripheral arteries (6,7) are also present among persons with diabetes. We assessed whether racial/ethnic differences in CAC, common and internal carotid intimal medial thickness (IMT), and the ankle brachial index (ABI) were evident in persons with diabetes in the MESA cohort and whether these differences persisted following adjustment for measured cardiovascular disease risk factors.
RESEARCH DESIGN AND METHODS
MESA is a multicenter study of 6,814 men and women aged 45–84 who were free from clinical CVD in 2000–2002 (8). From the cohort of 6,814 participants, we excluded 25 participants without glucose measurements and 5,761 without diabetes. Our final analysis sample included 204 whites, 387 blacks, 311 Hispanics, and 126 Chinese with diabetes. The prevalence of diabetes in the cohort by race/ethnicity is comparable to …
