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Racial differences in the significance of coronary calcium in asymptomatic black and white subjects with coronary
T M Doherty1, W Tang, R C Detrano
1Department of Medicine, Harbor-UCLA Medical Center and Saint John's Cardiovascular Research Center, Torrance, California 90502, USA.
Insights
High-risk Black individuals experience more coronary heart disease (CHD) events than Whites, despite lower coronary calcium prevalence. This suggests racial differences in CHD progression and significance of coronary calcium.
Area of Science:
- Cardiology
- Public Health
- Medical Research
Background:
- Coronary atherosclerosis progression and clinical outcomes differ between Black and White populations.
- Underlying pathobiology may explain ethnic variations in coronary atherosclerosis manifestation.
Purpose of the Study:
- To compare the significance of coronary calcium in asymptomatic Black and White individuals with coronary risk factors.
- To investigate ethnic differences in coronary atherosclerosis and its clinical impact.
Main Methods:
- Assessed coronary risk factors and coronary calcium in 1,375 high-risk, asymptomatic subjects (93 Black, 1282 White).
- Utilized digital subtraction fluoroscopy for coronary calcium evaluation.
- Followed subjects for 70 months to track coronary heart disease (CHD) events, myocardial infarction (MI), angina, and revascularization procedures.
Main Results:
- Coronary calcium prevalence was lower in Black subjects (35.5%) compared to White subjects (59.9%).
- Despite lower coronary calcium, Black subjects had a higher incidence of CHD events (23.7% vs. 14.8%).
- Black race was associated with a 2.16-fold increased odds of experiencing a coronary event after adjustment for risk factors.
Conclusions:
- High-risk Black individuals experience more CHD events than high-risk White individuals, irrespective of coronary calcium levels.
- Coronary calcium appears to have different pathobiologic significance in Black versus White populations.
- Racial disparities exist in the natural history and clinical evolution of coronary heart disease.
Objectives:
To compare the significance of a specific feature of coronary atherosclerosis--coronary calcium--in asymptomatic black and white subjects with coronary risk factors.
Background:
The natural history and clinical evolution of coronary atherosclerosis differs between blacks and whites. Differences in the underlying pathobiology of atherosclerosis may be one determinant of the ethnic variability in the clinical manifestation of coronary atherosclerosis.
Methods:
In 1,375 high-risk but asymptomatic subjects (93 blacks [6.8%] and 1,282 whites [93.2%]) with at least one risk factor but no prior evidence of coronary disease, we assessed coronary risk factors, calculated Framingham risk of a coronary event and evaluated coronary calcium with digital subtraction fluoroscopy. We then followed these subjects clinically for 70 +/- 13 months, noting the occurrence of the following coronary events: death due to coronary heart disease (CHD); myocardial infarction (MI); angina pectoris; and performance of coronary bypass or angioplasty.
Results:
Risk factor profiles were similar in black and white subjects (6-year Framingham risk 15 +/- 7% in blacks, 14 +/- 8% in whites [NS]). Coronary calcium was present in 59.9% of white subjects but only 35.5% of black subjects (p = 0.0001). Nevertheless, after 70 months of follow-up, more blacks than whites (22 blacks [23.7%] vs. 190 whites [14.8%]; p = 0.04) suffered one of the following end points: CHD death, MI, angina or revascularization. The age, gender and coronary risk-adjusted odds ratio of black race for at least one event was 2.16 (95% CI 1.34 to 3.48).
Conclusions:
Despite having a lowered prevalence of coronary calcium than high risk whites, high risk blacks suffer more CHD events. Coronary calcium therefore does not carry the same pathobiologic significance in blacks that it does in whites, consistent with the concept that there are specific racial differences in the natural history of CHD and its evolution into clinically manifest events.
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