Ethnic differences in metabolic cardiovascular risk among normal weight individuals: Implications for cardiovascular risk screening. The HELIUS study

Nutr Metab Cardiovasc Dis. 2019 Jan;29(1):15-22. doi: 10.1016/j.numecd.2018.09.004. Epub 2018 Sep 24.


Background and aims: Cardiovascular disease (CVD) risk factors may occur among a substantial proportion of normal weight individuals, particularly among some ethnic minorities. It is unknown how many of these individuals would be missed by commonly applied eligibility criteria for cardiovascular risk screening. Thus, we aim to determine cardiovascular risk and eligibility for cardiovascular risk screening among normal weight individuals of different ethnic backgrounds.

Methods and results: Using the HELIUS study (Amsterdam, The Netherlands), we determined cardiovascular risk among 6910 normal weight individuals of Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Moroccan and Turkish background. High cardiovascular risk was approximated by high metabolic risk based on blood pressure, HDL, triglycerides and fasting glucose. Eligibility criteria for screening were derived from Dutch CVD prevention guidelines and include age ≥ 50 y, family history of CVD, or current smoking. Ethnic group comparisons were made using logistic regression. Age-adjusted proportions of high metabolic risk ranged from 12.6% to 38.4% (men) and from 2.7% to 11.5% (women). This prevalence was higher among most ethnic minorities than the Dutch, especially among women. For most ethnic groups, 79.9%-86.7% of individuals with high metabolic risk were eligible for cardiovascular risk screening. Exceptions were Ghanaian women (58.8%), Moroccan men (70.9%) and Moroccan women (45.0%), although age-adjusted proportions did not differ between groups.

Conclusion: Even among normal weight individuals, high cardiovascular metabolic risk is more common among ethnic minorities than among the majority population. Regardless of ethnicity, most normal weight individuals with increased risk are eligible for cardiovascular risk screening.

Keywords: Cardiovascular risk screening; Ethnicity; HELIUS study; Metabolic disease; Normal weight.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Asian People*
  • Biomarkers / blood
  • Black People*
  • Blood Pressure
  • Body Weight / ethnology*
  • Cardiovascular Diseases / blood
  • Cardiovascular Diseases / diagnosis
  • Cardiovascular Diseases / ethnology*
  • Cardiovascular Diseases / physiopathology
  • Female
  • Ghana / ethnology
  • Health Status Disparities*
  • Humans
  • Male
  • Mass Screening / methods*
  • Middle Aged
  • Morocco / ethnology
  • Netherlands / epidemiology
  • Predictive Value of Tests
  • Prevalence
  • Risk Assessment
  • Risk Factors
  • Sex Factors
  • Suriname / ethnology
  • Turkey / ethnology
  • White People*


  • Biomarkers