{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T16:02:52Z","timestamp":1791388972345,"version":"4.3.3"},"reference-count":43,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"15","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2022,8,2]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">The major risk factors for atherosclerotic cardiovascular disease differ by race or ethnicity but have largely been defined using populations of European ancestry. Despite the rising prevalence of cardiovascular disease in Africa there are few related data from African populations. Therefore, we compared the association of established cardiovascular risk factors with carotid\u2010intima media thickness (CIMT), a subclinical marker of atherosclerosis, between African, African American, Asian, European, and Hispanic populations.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">Cross\u2010sectional analyses of 34\u00a0025 men and women drawn from 15 cohorts in Africa, Asia, Europe, and North America were undertaken. Classical cardiovascular risk factors were assessed and CIMT measured using B\u2010mode ultrasound. Ethnic differences in the association of established cardiovascular risk factors with CIMT were determined using a 1\u2010stage individual participant data meta\u2010analysis with beta coefficients expressed as a percentage using the White population as the reference group. CIMT adjusted for risk factors was the greatest among African American populations followed by Asian, European, and Hispanic populations with African populations having the lowest mean CIMT. In all racial or ethnic groups, men had higher CIMT levels compared with women. Age, sex, body mass index, and systolic blood pressure had a significant positive association with CIMT in all races and ethnicities at varying magnitudes. When compared with European populations, the association of age, sex, and systolic blood pressure with CIMT was weaker in all races and ethnicities. Smoking (beta coefficient, 0.39; 95% CI, 0.09\u20130.70), body mass index (beta coefficient, 0.05; 95% CI, 0.01\u20130.08) and glucose (beta coefficient, 0.13; 95% CI, 0.06\u20130.19) had the strongest positive association with CIMT in the Asian population when compared with all other racial and ethnic groups. High\u2010density lipoprotein\u2010cholesterol had significant protective effects in African American (beta coefficient, \u22120.31; 95% CI, \u22120.42 to \u22120.21) and African (beta coefficient, \u22120.26; 95% CI, \u22120.31 to \u22120.19) populations only.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">The strength of association between established cardiovascular risk factors and CIMT differed across the racial or ethnic groups and may be due to lifestyle risk factors and genetics. These differences have implications for race\u2010 ethnicity\u2010specific primary prevention strategies and also give insights into the differential contribution of risk factors to the pathogenesis of cardiovascular disease. The greatest burden of subclinical atherosclerosis in African American individuals warrants further investigations.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.121.023704","type":"journal-article","created":{"date-parts":[[2022,7,25]],"date-time":"2022-07-25T12:03:54Z","timestamp":1658750634000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":29,"title":["Racial and Ethnic Differences in the Association Between Classical Cardiovascular Risk Factors and Common Carotid Intima\u2010Media Thickness: An Individual Participant Data Meta\u2010Analysis"],"prefix":"10.1161","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8491-6478","authenticated-orcid":false,"given":"Engelbert A.","family":"Nonterah","sequence":"first","affiliation":[{"name":"Navrongo Health Research Centre Ghana Health Service Navrongo Ghana"},{"name":"Julius Global Health Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht University Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5766-1745","authenticated-orcid":false,"given":"Nigel J.","family":"Crowther","sequence":"additional","affiliation":[{"name":"Department of Chemical Pathology Faculty of Health Sciences National Health Laboratory Service University of the Witwatersrand Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5462-9889","authenticated-orcid":false,"given":"Kerstin","family":"Klipstein\u2010Grobusch","sequence":"additional","affiliation":[{"name":"Julius Global Health Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht University Utrecht the Netherlands"},{"name":"Division of Epidemiology and Biostatistics School of Public Health Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4191-7419","authenticated-orcid":false,"given":"Abraham R.","family":"Oduro","sequence":"additional","affiliation":[{"name":"Navrongo Health Research Centre Ghana Health Service Navrongo Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5976-6519","authenticated-orcid":false,"given":"Maryam","family":"Kavousi","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Erasmus University Medical Centre Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4218-5424","authenticated-orcid":false,"given":"Godfred","family":"Agongo","sequence":"additional","affiliation":[{"name":"Navrongo Health Research Centre Ghana Health Service Navrongo Ghana"},{"name":"Department of Biochemistry and Forensic Science CK Tedam University of Technology and Applied Sciences (UTAS) Navrongo Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd J.","family":"Anderson","sequence":"additional","affiliation":[{"name":"Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta University of Calgary Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9966-1153","authenticated-orcid":false,"given":"Gershim","family":"Asiki","sequence":"additional","affiliation":[{"name":"African Population and Health Research Centre (APHRC) Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8325-2665","authenticated-orcid":false,"given":"Palwend\u00e9 R.","family":"Boua","sequence":"additional","affiliation":[{"name":"Clinical Research Unit of Nanoro Institut de Recherch\u00e9 en Sciences de la Sant\u00e9 Nanoro Burkina Faso"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1338-6523","authenticated-orcid":false,"given":"Solomon S. R.","family":"Choma","sequence":"additional","affiliation":[{"name":"Department of Pathology and Medical Sciences DIMAMO Health and Demographic Surveillance System University of Limpopo South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4313-9235","authenticated-orcid":false,"given":"David J.","family":"Couper","sequence":"additional","affiliation":[{"name":"Collaborative Studies Coordinating Center Department of Biostatistics University of North Carolina at Chapel Hill NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8618-9152","authenticated-orcid":false,"given":"Gunnar","family":"Engstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences in Malm\u00f6 Lund University Sk\u00e5ne University Hospital Malm\u00f6 Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline","family":"de Graaf","sequence":"additional","affiliation":[{"name":"Division of Vascular Medicine Department of General Internal Medicine Nijmegen University Medical Centre Nijmegen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jussi","family":"Kauhanen","sequence":"additional","affiliation":[{"name":"The Institute of Public Health and clinical Nutrition School of Medicine Faculty of Health Sciences University of Eastern Finland (UEF) Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva M.","family":"Lonn","sequence":"additional","affiliation":[{"name":"Division of Cardiology and Population Health Research Institute Department of Medicine McMaster University Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8887-6100","authenticated-orcid":false,"given":"Ellisiv B.","family":"Mathiesen","sequence":"additional","affiliation":[{"name":"Brain and Circulation Research Group Institute of Clinical Medicine University of Troms\u00f8 Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4994-0779","authenticated-orcid":false,"given":"Lisa K.","family":"Micklesfield","sequence":"additional","affiliation":[{"name":"South African Medical Research Council\/Developmental Pathways for Health Research Unit (DPHRU) Department of Paediatrics School of Clinical Medicine Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5789-2893","authenticated-orcid":false,"given":"Shuhei","family":"Okazaki","sequence":"additional","affiliation":[{"name":"Department of Neurology, Stroke Center Osaka University Graduate School of Medicine Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2459-083X","authenticated-orcid":false,"given":"Joseph F.","family":"Polak","sequence":"additional","affiliation":[{"name":"Department of Radiology Tufts Medical Center Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7115-9815","authenticated-orcid":false,"given":"Tatjana","family":"Rundek","sequence":"additional","affiliation":[{"name":"University of Miami Miller School of Medicine Miami FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jukka T.","family":"Salonen","sequence":"additional","affiliation":[{"name":"MAS\u2010Metabolic Analytical Services Oy Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0744-7588","authenticated-orcid":false,"given":"Stephen M.","family":"Tollman","sequence":"additional","affiliation":[{"name":"South African Medical Research Council\/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) School of Public Health Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomi\u2010Pekka","family":"Tuomainen","sequence":"additional","affiliation":[{"name":"The Institute of Public Health and clinical Nutrition School of Medicine Faculty of Health Sciences University of Eastern Finland (UEF) Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diederick E.","family":"Grobbee","sequence":"additional","affiliation":[{"name":"Julius Global Health Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht University Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4156-4801","authenticated-orcid":false,"given":"Mich\u00e9le","family":"Ramsay","sequence":"additional","affiliation":[{"name":"Sydney Brenner Institute of Molecular Bioscience Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2871-9810","authenticated-orcid":false,"given":"Michiel L.","family":"Bots","sequence":"additional","affiliation":[{"name":"Julius Global Health Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht University Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the H3Africa AWI\u2010Gen, USE\u2010IMT collaborative study group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31679-8"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.5334\/gh.403"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosis.2015.03.021"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.28.5.929"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(01)01748-X"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0132321"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)17018-9"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)32008-2"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.4103\/0366-6999.173500"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.118.011506"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.9630"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1080\/16549716.2018.1507133"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.953653"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.25.12.2377"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosis.2006.05.007"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosis.2007.03.044"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2796.1991.tb00336.x"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/152.4.334"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.31.3.574"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2009-0084"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1159\/000103114"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.289.20.2709"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1037\/0022-0167.54.3.271"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1007\/S40037-020-00602-3"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1177\/1358863X20969826"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(20)30036-9"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz455"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000625"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1910355"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2009.01.002"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1186\/gb-2009-10-12-r141"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajhg.2020.06.012"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosis.2011.08.028"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.116.003529"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1038\/mp.2011.124"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1079\/PNS2003327"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.numecd.2014.07.008"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwh229"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.gheart.2017.01.011"},{"key":"e_1_3_2_41_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.115.002436"},{"key":"e_1_3_2_42_2","doi-asserted-by":"publisher","DOI":"10.1161\/hc4601.099487"},{"key":"e_1_3_2_43_2","doi-asserted-by":"publisher","DOI":"10.4103\/1995-705X.185130"},{"key":"e_1_3_2_44_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.120.046361"}],"updated-by":[{"DOI":"10.1161\/jaha.121.027548","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2023,2,15]],"date-time":"2023-02-15T00:00:00Z","timestamp":1676419200000}}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.121.023704","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T11:14:51Z","timestamp":1715598891000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.121.023704"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,2]]},"references-count":43,"journal-issue":{"issue":"15","published-print":{"date-parts":[[2022,8,2]]}},"alternative-id":["10.1161\/JAHA.121.023704"],"URL":"https:\/\/doi.org\/10.1161\/jaha.121.023704","relation":{"correction":[{"id-type":"doi","id":"10.1161\/JAHA.121.027548","asserted-by":"object"}]},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,2]]},"assertion":[{"value":"2021-10-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-03-21","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-07-25","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e023704"}}