Obesity, Diabetes, and Acute Coronary Syndrome: Differences Between Asians and Whites

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, John H. Alexander

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Background Most diabetes and cardiovascular studies have been conducted in white patients, with data being extrapolated to other population groups. Methods For 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. Results We 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. Conclusions Although 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.

Original languageEnglish
Pages (from-to)1170-1176
Number of pages7
JournalAmerican Journal of Medicine
Issue number10
StatePublished - Oct 2017

Bibliographical note

Publisher Copyright:
© 2017 Elsevier Inc.


  • Acute coronary syndrome
  • Diabetes
  • Ischemic outcomes
  • Obesity
  • Race

ASJC Scopus subject areas

  • General Medicine


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