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Ethnic differences of the presence and severity of coronary atherosclerosis
Matthew J Budoff1, Khurram Nasir, Songshou Mao
1Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, 1124 W Carson Street, Bldg RB-2, Torrance, CA, USA. budoff@ucla.edu
Insights
Ethnic differences in coronary artery calcification exist, independent of traditional risk factors. African-American women showed higher calcification, while Asian men and women showed lower calcification rates.
Area of Science:
- Cardiology
- Public Health
- Medical Imaging
Background:
- Cardiovascular risk factors vary significantly across ethnic groups (Caucasians, African-Americans, Hispanics, Asians).
- Observed coronary heart disease rates do not consistently align with these risk factor disparities.
- Atherosclerosis, measured by coronary artery calcification, requires ethnic-specific investigation.
Purpose of the Study:
- To assess ethnic variations in the prevalence and severity of coronary artery calcification.
- To investigate atherosclerosis differences across Caucasian, African-American, Hispanic, and Asian populations.
- To determine if ethnic disparities in calcification persist after accounting for risk factors.
Main Methods:
- Electron-beam tomography (EBT) utilized for asymptomatic individuals aged 35 years and older.
- Study included 16,560 participants: 1336 Asians, 610 African-Americans, 1256 Hispanics, and a substantial Caucasian cohort.
- Population comprised 70% males, with an average age of 52±8 years, referred for cardiovascular risk evaluation.
Main Results:
- African-American men had lower coronary calcification risk (RR=0.64) compared to Caucasians, while African-American women had higher risk (RR=1.58).
- Asian men and women exhibited significantly lower coronary calcification risk (RR=0.66 and RR=0.71, respectively) versus Caucasians.
- Hispanics showed no significant difference in calcification prevalence or severity compared to Caucasians, for both men and women.
Conclusions:
- Significant ethnic differences in coronary calcification prevalence and severity are evident, independent of atherosclerotic risk factors.
- Findings align with population-based studies like MESA, reinforcing the need for ethnic-specific data.
- Further research is required on the predictive value of coronary calcium scores across diverse ethnicities.
Background:
Although cardiovascular risk factor levels are substantially different in Caucasians, African-American, Hispanics, and Asians, the relative rates of coronary heart disease in these groups are not consistent with these differences. The objective of the study is to assess the differences in the prevalence and severity of coronary artery calcification, as a measure of atherosclerosis, in these different ethnic groups.
Methods:
Electron-beam tomography was performed in 16,560 asymptomatic men and women (Asians=1336, African-Americans=610, Hispanics=1256) aged >or=35 years referred by their physician for cardiovascular risk evaluation. The study population encompassed 70% males, aged 52+/-8 years.
Results:
Caucasians were more likely to present with dyslipidemia (p<0.0001), while African-Americans and Hispanics had a higher prevalence of smoking, diabetes, and hypertension (all p<0.001). After adjustment for age, gender, risk factors, and treatment for hypercholesterolemia, compared with Caucasians, the relative risks for men having coronary calcification were 0.64 (95% CI: 0.48-0.86) in African-Americans, 0.88 (95% CI: 0.67-1.15) in Hispanics, and 0.66 (95% CI: 0.55-0.80) in Asians. After similar adjustments, the relative risks for women having coronary calcification, were 1.58 (95% CI: 1.13-2.19) for African-Americans, 0.84 (95% CI: 0.66-1.06) in Hispanics, and 0.71 (95% CI: 0.56-0.89) in Asian women. After adjusting for age and risk factors using multivariable analysis, African-American men were least likely to have any coronary calcium while African-American women had significantly higher OR of any calcification. Asian men and women had significantly lower OR of any calcification. There was no significant difference in prevalence or severity of atherosclerosis between Hispanics and Caucasians, in men or women.
Conclusions:
Our study results demonstrate significant difference in the presence as well as severity of calcification according to ethnicity, independent of atherosclerotic risk factors. Results from this study (physician referred) closely parallel the results from MESA (population based, measured risk factors). Ethnic specific data on the predictive value of differing coronary calcium scores are needed.
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