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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Ethnic differences in the prognostic value of coronary artery calcification for all-cause mortality
Khurram Nasir1, Leslee J Shaw, Sandy T Liu
1Cardiac MRI PET CT Program, Massachusetts General Hospital Boston, Harvard School of Medicine, Boston, Massachusetts, USA.
Insights
Coronary artery calcium (CAC) effectively predicts mortality across diverse ethnicities, with African Americans showing the highest risk, especially with elevated CAC scores. These findings highlight significant cardiovascular risk disparities by ethnicity.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Heart disease case fatality rates show significant disparities among ethnic groups.
- African Americans (AA) experienced 30% higher heart disease mortality rates than non-Hispanic whites (NHW) in 2001.
- These disparities may stem from differing pathophysiological mechanisms and atherosclerosis effects.
Purpose of the Study:
- To assess the prognostic value of coronary artery calcium (CAC) for predicting all-cause mortality.
- To evaluate CAC in a large, ethnically diverse cohort of 14,812 patients.
- To understand ethnic variations in cardiovascular risk prediction using CAC.
Main Methods:
- Compared 10-year all-cause mortality rates (505 deaths) across ethnic groups: AA (n=637), Hispanic (HS, n=1,334), Asian (AS, n=1,065), and NHW (n=11,776).
- Utilized risk-adjusted Cox proportional hazards models for analysis.
- Examined the association between CAC scores and mortality risk across different ethnicities.
Main Results:
- Ethnic minority patients were younger, more often had diabetes and hypertension, and were more frequently female.
- Prevalence of CAC scores ≥100 was highest in NHW (31%) and lowest in HS (18%).
- Overall survival was lowest for AA (83%) compared to AS (96%), NHW (93%), and HS (92%).
- Relative risk ratios for mortality were highest for AA with CAC ≥400 (exceeding 16.1) and for HS with CAC ≥400 (7.9-9.0).
- AS with CAC ≥1,000 showed a 6.6-fold higher mortality risk than NHW.
Conclusions:
- African Americans with increasing subclinical coronary artery disease burden represent the highest-risk ethnic minority group.
- These findings underscore substantial differences in cardiovascular risk stratified by ethnicity.
- CAC is a valuable prognostic marker, particularly for identifying high-risk ethnic minority populations.
Objectives:
The purpose of this study was to evaluate the prognostic value of coronary artery calcium (CAC), a known marker of subclinical atherosclerosis, in a large, ethnically diverse cohort of 14,812 patients for the prediction of all-cause mortality.
Background:
Disparities in case fatality rates for heart disease among ethnic groups are well known. In 2001, rates of death from heart disease were 30% higher among African Americans (AA) than non-Hispanic whites (NHW). Some of this variability may be due to differing pathophysiological mechanisms and effects of underlying atherosclerosis.
Methods:
Ten-year death rates from all causes (total deaths = 505) were compared using risk-adjusted Cox proportional hazards models in AA (n = 637), Hispanic (HS, n = 1,334), Asian (AS, n = 1,065), and NHW (n = 11,776) populations.
Results:
Ethnic minority patients were generally younger (0.3 to 4 years), more often persons with diabetes (p < 0.0001), hypertensive (p < 0.0001), and female (p < 0.0001). The prevalence of CAC scores > or =100 was highest in NHW (31%) and lowest for HS (18%) (p < 0.0001). Overall survival was 96%, 93%, and 92% for AS, NHW, and HS, respectively, as compared with 83% for AA (p < 0.0001). When comparing prognosis by CAC scores in ethnic minorities as compared with NHW, relative risk ratios were highest for AA with CAC scores > or =400 exceeding 16.1 (p < 0.0001). Hispanics with CAC scores > or =400 had relative risk ratios from 7.9 to 9.0, whereas AS with CAC scores > or =1,000 had relative risk ratios 6.6-fold higher than NHW (p < 0.0001).
Conclusions:
Consistent with population evidence, AA with increasing burden of subclinical coronary artery disease were the highest-risk ethnic minority population. These data support a growing body of evidence noting substantial differences in cardiovascular risk by ethnicity.
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