The Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS): Design and Methodology

Abstract

Background. Each year, approximately 5000 New Zealanders are admitted to hospital with first-time acute coronary syndrome (ACS). The Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS) is a prospective longitudinal cohort study embedded within the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry in six hospitals. The objective of MENZACS is to examine the relationship between clinical, genomic, and cardiometabolic markers in relation to presentation and outcomes post-ACS. Methods. Patients with first-time ACS are enrolled and study-specific research data is collected alongside the ANZACS-QI registry. The research blood samples are stored for future genetic/biomarker assays. Dietary information is collected with a food frequency questionnaire and information about physical activity, smoking, and stress is also collected via questionnaire. Detailed family history, ancestry, and ethnicity data are recorded on all participants. Results. During the period between 2015 and 2019, there were 2015 patients enrolled. The mean age was 61 years, with 60% of patients aged <65 years and 21% were female. Ethnicity and cardiovascular (CV) risk factor distribution was similar to ANZACS-QI: 13% Māori, 5% Pacific, 5% Indian, and 74% NZ European. In terms of CV risk factors, 56% were ex-/current smokers, 42% had hypertension, and 19% had diabetes. ACS subtype was ST elevation myocardial infarction (STEMI) in 41%, non-ST elevation myocardial infarction (NSTEM) in 54%, and unstable angina in 5%. Ninety-nine percent of MENZACS participants underwent coronary angiography and 90% had revascularization; there were high rates of prescription of secondary prevention medications upon discharge from hospital. Conclusion. MENZACS represents a cohort with optimal contemporary management and will be a significant epidemiological bioresource for the study of environmental and genetic factors contributing to ACS in New Zealand’s multi-ethnic environment. The study will utilise clinical, nutritional, lifestyle, genomic, and biomarker analyses to explore factors influencing the progression of coronary disease and develop risk prediction models for health outcomes.

The Inclusion of Underrepresented Populations in Cardiovascular Genetics and Epidemiology

“…Recognizing this, a major step in increasing representation has been addressing the paucity of diverse genetic biobanks. For example, Legget et al (2021) detail a large-scale project, the Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS), which comprises a large diverse biobank for future prospective study of the genetic factors influencing ACS [110]-the represented populations include Māori, Pacific, Indian, and NZ European.…”

“…Calls for dedicated recruitment of diverse cohorts for genetics research are ongoing given the continuing paucity of underrepresented populations in clinically impactful studies [93,94,146]. Several large-scale endeavors are responding to these recommendations, including the development of multi-ethnic biobanks that can be used for genetics research purposes [103][104][105][106][107][108]110]. Given the sheer number of data points needed for wellpowered genetics studies, the cost-benefit in the case of large-scale biobank development is evident [147].…”

Examining Acute Coronary Syndrome Across Ethnicity, Sex, and Age

“…13 Many current publications are investigating genetic variations through genome-wide association studies that may help elucidate the variations in ACS presentation among ethnic and racial groups. 14,15 African American Population…”

Prognostic modelling of clinical outcomes after first-time acute coronary syndrome in New Zealand

“…The Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS) is an ongoing prospective, longitudinal cohort study established to assess the drivers of clinical outcomes for patients following ACS. The broad aims include to better understand the factors underlying inequities in cardiovascular health outcomes in NZ and then to target interventions to reduce recurrent events 4…”