TABLE 3. Associations (odds ratios and 95% confidence interval) between risk factors and brain infarct, and severe white matter hyperintensity by ethnicity.
| Brain infarct |
Severe white matter hyperintensity |
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|---|---|---|---|---|---|---|---|---|
| European |
African Caribbean |
European |
African Caribbean |
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| Variable | OR (95% CI) | P | OR (95% CI) | P | OR (95% CI) | P | OR (95% CI) | P |
| Age (years) | 1.08 (1.05–1.12) | <0.0001 | 1.11 (1.05–1.18) | 0.001 | 1.14 (1.11–1.18) | <0.0001 | 1.15 (1.09–1.21) | <0.0001 |
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| Sex (men versus women) | 0.90 (0.55–1.47) | 0.7 | 1.04 (0.55–1.99) | 0.9 | 1.09 (0.72–1.64) | 0.7 | 0.78 (0.45–1.34) | 0.4 |
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| Clinic SBP (mmHg) | 1.02 (1.00–1.03) | 0.009 | 1.03 (1.01–1.05) | 0.001 | 1.02 (1.01–1.03) | <0.0001 | 1.03 (1.01–1.04) | 0.002 |
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| Clinic DBP (mmHg) | 0.98 (0.96–1.00) | 0.1 | 1.02 (0.98–1.05) | 0.4 | 0.99 (0.98–1.01) | 0.3 | 1.00 (0.97–1.03) | 0.9 |
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| Clinic MAP (mmHg) | 1.00 (0.99–1.02) | 0.6 | 1.04(1.01–1.07) | 0.02 | 1.01 (1.00–1.03) | 0.07 | 1.02 (1.00–1.05) | 0.09 |
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| Clinic PP (mmHg) | 1.03 (1.01–1.04) | <0.0001 | 1.05 (1.02–1.07) | <0.0001 | 1.04 (1.02–1.05) | <0.0001 | 1.04 (1.02–1.07) | <0.0001 |
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| Central SBP (mmHg) | 1.02 (1.01–1.03) | 0.008 | 1.03 (1.01–1.06) | 0.003 | 1.02 (1.00–1.03) | 0.006 | 1.02 (1.00–1.04) | 0.06 |
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| Central PP (mmHg) | 1.02 (1.00–1.03) | 0.01 | 1.05 (1.02–1.08) | 0.001 | 1.02 (1.01–1.04) | 0.001 | 1.02 (1.00–1.05) | 0.06 |
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| TAC (ml/mmHg) | 0.41 (0.21–0.78) | 0.006 | 0.21 (0.06–0.73) | 0.01 | 0.27 (0.15–0.48) | <0.0001 | 0.33 (0.12–0.87) | 0.03 |
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| Antihypertensive medication | 2.26 (1.49–3.43) | <0.0001 | 5.92 (1.75–20.0) | 0.004 | 2.17 (1.53–3.09) | <0.0001 | 3.13 (1.53–6.41) | 0.002 |
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| Hypertension | 1.99 (1.23–3.24) | 0.005 | 4.33 (0.99–18.97) | 0.05 | 1.86 (1.25–2.77) | 0.002 | 3.33 (1.30–8.56) | 0.01 |
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| History of stroke | 4.84 (2.24–10.47) | <0.0001 | 3.36 (1.30–8.68) | 0.01 | 2.12 (0.99–4.54) | 0.05 | 3.47 (1.28–9.42) | 0.02 |
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| Atrial fibrillation | 1.98 (1.07–3.66) | 0.03 | - | - | 1.56 (0.88–2.78) | 0.1 | - | - |
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| Prevalent CHD | 1.85 (1.11–3.08) | 0.02 | 3.60 (1.31–9.93) | 0.01 | 1.28 (0.79–2.05) | 0.3 | 2.00 (0.73–5.48) | 0.2 |
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| Brain infarct on MRI | - | - | - | - | 5.03 (3.32–7.62) | <0.0001 | 6.49 (3.07–13.70) | <0.0001 |
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| Severe WMH on MRI | 5.03 (3.32–7.62) | <0.0001 | 6.49 (3.07–13.70) | <0.0001 | - | - | - | - |
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| Diabetes | 1.17 (0.72–1.91) | 0.5 | 2.15 (1.12–4.14) | 0.02 | 1.32 (0.87–2.02) | 0.2 | 2.52 (1.44–4.41) | 0.001 |
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| HbA1c(%) | 1.23 (0.96–1.58) | 0.1 | 0.99 (0.74–1.32) | 0.9 | 1.24 (0.99–1.56) | 0.06 | 1.31 (1.02–1.69) | 0.04 |
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| Glucose (mmol/l)a | 1.10 (0.96–1.26) | 0.2 | 1.14(0.95–1.38) | 0.2 | 2.17 (0.91–5.17) | 0.08 | 2.38 (0.72–7.89) | 0.2 |
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| Fasting insulin (μU/ml)a | 1.17 (0.86–1.58) | 0.3 | 0.95 (0.58–1.54) | 0.8 | 1.10 (0.85–1.43) | 0.5 | 1.11 (0.74–1.67) | 0.6 |
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| HOMA-IRa | 1.19 (0.88–1.61) | 0.3 | 0.96 (0.59–1.55) | 0.9 | 1.12 (0.82–1.45) | 0.4 | 1.12 (0.75–1.69) | 0.6 |
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| Urine ACR (mg/mmol)a | 1.35 (1.15–1.59) | <0.0001 | 1.10(0.84–1.45) | 0.5 | 1.36 (1.17–1.58) | <0.0001 | 1.38 (1.08–1.76) | 0.01 |
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| Cholesterol (mmol/l) | 0.86 (0.72–1.03) | 0.1 | 0.99 (0.73–1.34) | 1.0 | 0.81 (0.69–0.95) | 0.01 | 0.85 (0.66–1.10) | 0.2 |
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| HDL cholesterol (mmol/l) | 0.75 (0.42–1.34) | 0.3 | 1.29 (0.55–3.04) | 0.6 | 1.37 (0.84–2.22) | 0.2 | 0.87 (0.42–1.82) | 0.7 |
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| Ever smoker | 1.47 (0.69–3.13) | 0.3 | 4.41 (1.20–16.14) | 0.03 | 0.73 (0.51–1.04) | 0.08 | 1.19 (0.66–2.14) | 0.6 |
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| Alcohol at least once weekly versus not |
0.70 (0.42–1.17) | 0.2 | 0.81 (0.38–1.72) | 0.6 | 0.90 (0.50–1.64) | 0.7 | 0.80 (0.38–1.72) | 0.6 |
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| ABPM subgroup | Brain infarct | Severe white matter hyper intensity | ||||||
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| European | African Caribbean | European | African Caribbean | |||||
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| OR (95% CI) | P | OR (95% CI) | P | OR (95% CI) | P | OR (95% CI) | P | |
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| Daytime SBP (mmHg) | 1.02 (1.00–1.05) | 0.07 | 0.99 (0.95–1.02) | 0.4 | 1.03 (1.00–1.05) | 0.02 | 1.03 (1.00–1.07) | 0.07 |
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| Daytime DBP (mmHg) | 1.00 (0.96–1.03) | 0.8 | 0.95 (0.90–1.01) | 0.1 | 0.99 (0.95–1.02) | 0.4 | 1.00 (0.95–1.05) | 1.0 |
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| Night-time SBP (mmHg) | 1.03 (1.01–1.05) | 0.005 | 1.02 (0.98–1.05) | 0.3 | 1.04 (1.02–1.07) | <0.0001 | 1.08 (1.04–1.12) | <0.0001 |
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| Night-time DBP (mmHg) | 1.02 (0.99–1.05) | 0.3 | 1.00 (0.95–1.06) | 0.9 | 1.03 (1.00–1.06) | 0.06 | 1.07 (1.01–1.13) | 0.01 |
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| Systolic dip (%) | 0.96 (0.92–1.00) | 0.03 | 0.94 (0.88–1.00) | 0.05 | 0.94 (0.90–0.97) | 0.001 | 0.93 (0.88–0.99) | 0.02 |
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| Diastolic dip (%) | 0.97 (0.94–1.01) | 0.1 | 0.95 (0.90–1.00) | 0.04 | 0.95 (0.92–0.98) | 0.003 | 0.94 (0.89–0.99) | 0.01 |
Risks of subclinical cerebrovascular disease in association with atrial fibrillation in African Caribbeans are not presented as numbers are too small. ABPM, ambulatory blood pressure monitoring; CHD, coronary heart disease; CI, confidence interval; HOMA-IR, homeostasis model assessment of insulin resistance; MAP, mean arterial pressure; OR, odds ratio; PP, pulse pressure; TAC, total arterial compliance.
a
Log-transformed variable.