Diabetes-Related Heart Disease Risk Varies by Body Size Phenotype Among Blacks in the USVI

Objective:-- Caribbean Blacks (CB) have low rates of heart disease (HD) but high rates of diabetes mellitus (DM). This study determined if, among CB, the presence of DM differentially influences HD risk across body size phenotypes.

Methods:-- Demographic, lifestyle and anthropometric data were collected and fasting blood samples measured for glucose, insulin and serum lipids from a population based sample of CB living in the US Virgin Islands (USVI).  Participants were grouped into body size phenotypes including, “metabolically abnormal normal weight” (MANW) (n=59), “metabolically abnormal overweight” (MAOW) (n=116) & “metabolically abnormal obese” (MAOB) (n=168), based on clustering of ≥ 2 metabolic abnormalities and body mass index.  HD was determined by self-report with verification through medication use. 

Results:-- In analyses excluding known diabetics, MANW persons had a higher frequency (6.98%) of HD compared to MAOW (3.37%) and MAOB (2.26%).   These differences were not significant after adjusting for age, sex, and smoking status.  When including known diabetics, a greater increase in frequency of HD was found for those with MANW and a significant linear trend (P=.0117) was observed across the groups.  The odds ratio (OR) for HD when relating MANW to MAOW status was 1.82 (95% CI= 0.75 – 4.41) among persons without known diabetes.  However, when known diabetics were included, the corresponding OR (2.21 (95% CI= 1.13 – 4.35)) increased significantly (p<.05).

Conclusion:-- The effect of DM on risk of HD appears greater for the MANW phenotype among Caribbean Blacks in the USVI.