Ethnic differences in the burden of cardiovascular disease risk factors among adult residents of London: the TOGETHER study
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Type
Journal Article
Abstract
Background: Cardiovascular disease (CVD) remains the leading cause of premature death in England, with ethnic minority populations disproportionately affected, largely due to differences in socioeconomic factors, exposure and/or susceptibility to CVD risk factors. Midlife risk assessment does not fully account for observed variation in CVD incidence and mortality. Early and precise quantification of risk factor burden across diverse populations is therefore essential to inform targeted prevention strategies. This study assessed the prevalence of CVD risk factors in apparently healthy individuals residing in London.
Methods: This cross-sectional study included CVD-free individuals aged 30–90 years residing in London and registered with general practices using the Egton Medical Information Systems (EMIS) electronic health record system. Unadjusted, crude estimates of traditional CVD risk factors were assessed across participants of different ethnicities who underwent a CVD risk assessment between 2009-2020.
Results: Among 607,327 registered individuals, 83,414 were included (52.0% women, median age 45 [IQR:36-48] years). Ethnic distribution was: White (43.6%), Asian (30.1%), Black (9.7%), Chinese/Other (4.0%), Mixed (2.1%). Overall, 7.8% were current smokers, 31.5% had obesity [universally defined as body mass index (BMI)≥30.0 kg/m2], 48.5% had elevated blood pressure (BP≥140/90 mmHg), 44.9% had hypercholesterolemia (≥5.0 mmol/l), 28.2% had elevated triglycerides (TG)≥1.7 mmol/l and 25.9% had low high-density lipoprotein cholesterol (HDL-C<1.0/1.3 mmol/l for males/females, respectively). Smoking prevalence was highest among White individuals (9.7%). Obesity prevalence varied across groups, with higher proportions in Black participants (42.3%) and lower in Asian individuals (26.1%). Elevated BP was recorded more frequently in Mixed (54.9%) and Black (53.0%) participants and less frequently in those classified as Chinese/Other (42.7%). Total cholesterol ≥5.0 mmol/L was more commonly documented in Mixed (56.8%) and White (49.8%) participants. Higher proportions of Asian individuals had elevated TG (30.9%) and low HDL-C (31.6%), while corresponding proportions were lower among Black participants (14.4% and 19.5%, respectively).
Conclusions: This large-scale analysis of a diverse population suggests variation in CVD risk factor burden among relatively young individuals without CVD. While not implying causality, these findings reflect inequalities between ethnic groups and support an appraisal of early, tailored, and equitable public health policies to improve CVD risk management across diverse populations.
Methods: This cross-sectional study included CVD-free individuals aged 30–90 years residing in London and registered with general practices using the Egton Medical Information Systems (EMIS) electronic health record system. Unadjusted, crude estimates of traditional CVD risk factors were assessed across participants of different ethnicities who underwent a CVD risk assessment between 2009-2020.
Results: Among 607,327 registered individuals, 83,414 were included (52.0% women, median age 45 [IQR:36-48] years). Ethnic distribution was: White (43.6%), Asian (30.1%), Black (9.7%), Chinese/Other (4.0%), Mixed (2.1%). Overall, 7.8% were current smokers, 31.5% had obesity [universally defined as body mass index (BMI)≥30.0 kg/m2], 48.5% had elevated blood pressure (BP≥140/90 mmHg), 44.9% had hypercholesterolemia (≥5.0 mmol/l), 28.2% had elevated triglycerides (TG)≥1.7 mmol/l and 25.9% had low high-density lipoprotein cholesterol (HDL-C<1.0/1.3 mmol/l for males/females, respectively). Smoking prevalence was highest among White individuals (9.7%). Obesity prevalence varied across groups, with higher proportions in Black participants (42.3%) and lower in Asian individuals (26.1%). Elevated BP was recorded more frequently in Mixed (54.9%) and Black (53.0%) participants and less frequently in those classified as Chinese/Other (42.7%). Total cholesterol ≥5.0 mmol/L was more commonly documented in Mixed (56.8%) and White (49.8%) participants. Higher proportions of Asian individuals had elevated TG (30.9%) and low HDL-C (31.6%), while corresponding proportions were lower among Black participants (14.4% and 19.5%, respectively).
Conclusions: This large-scale analysis of a diverse population suggests variation in CVD risk factor burden among relatively young individuals without CVD. While not implying causality, these findings reflect inequalities between ethnic groups and support an appraisal of early, tailored, and equitable public health policies to improve CVD risk management across diverse populations.
Date Issued
2026-04-10
Date Acceptance
2026-02-18
Citation
BMC Medicine, 2026, 24 (1)
ISSN
1741-7015
Publisher
BMC
Journal / Book Title
BMC Medicine
Volume
24
Issue
1
Copyright Statement
© The Author(s) 2026. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
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Identifier
10.1186/s12916-026-04739-6
Publication Status
Published
Article Number
ARTN 220
Date Publish Online
2026-03-03