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Racial differences in the burden of coronary artery calcium and carotid intima media thickness between Blacks and
S Erqou1, K E Kip, S R Mulukutla
1Department of Medicine, Weill Cornell Medical College, 525 E 68th Street, Box 130, New York, NY, 10065, USA, see9003@med.cornell.edu.
Insights
Black individuals have higher carotid intima media thickness (CIMT) but lower coronary artery calcium (CAC) compared to White individuals. These racial differences in subclinical atherosclerosis warrant race-specific cardiovascular disease (CVD) risk algorithms.
Area of Science:
- Cardiovascular Disease Research
- Atherosclerosis Studies
- Racial Disparities in Health
Background:
- Understanding racial differences in subclinical atherosclerosis is crucial for developing accurate cardiovascular disease (CVD) risk prediction.
- Carotid intima media thickness (CIMT) and coronary artery calcium (CAC) are key indicators of atherosclerosis.
Purpose of the Study:
- To investigate racial differences in the prevalence and correlates of CIMT and CAC.
- To inform the development of race-specific CVD risk algorithms.
Main Methods:
- The Heart SCORE study analyzed CIMT and CAC in 792 and 776 individuals, respectively, with a significant proportion of Black participants.
- CIMT was measured using carotid ultrasonography, and CAC was quantified by electron beam computed tomography.
- Logistic regression models assessed cross-sectional associations between race, CIMT, and CAC.
Main Results:
- Black individuals exhibited greater CIMT and higher odds of significant CIMT compared to White individuals.
- Conversely, Black individuals had less CAC and lower odds of significant CAC compared to White individuals.
- These associations remained consistent even after adjusting for traditional CVD risk factors.
Conclusions:
- Black race is independently linked to increased CIMT but decreased CAC relative to White race.
- Race-specific algorithms incorporating CIMT and CAC measures are recommended for improved CVD risk stratification.
Background:
Identification of racial differences in the burden and correlates of carotid intima media thickness (CIMT) and coronary artery calcium (CAC) may provide the basis for the development of race-specific cardiovascular disease (CVD) risk prediction algorithms.
Methods:
In the Heart Strategies Concentrating on Risk Evaluation (Heart SCORE) study, CIMT was measured by carotid ultrasonography in 792 individuals (35 % Black). CIMT >1 mm was considered significant. CAC was quantified by electron beam computed tomography in 776 individuals (46 % Black). CAC was considered significant if the Agatston score was >100. Cross-sectional associations between race, CIMT and CAC were assessed using logistic regression models.
Results:
Blacks had greater CIMT (mean difference 0.033 mm, 95 % CI 0.005-0.06 mm; p = 0.02) and 1.5-fold (95 % CI 1.0-2.3) higher odds of having significant CIMT than Whites. Blacks had less CAC than Whites (mean Agatston score difference 66, [11-122]; p = 0.02) and 50 % lower odds of a significant CAC score compared with Whites (0.5 [0.3-0.7]). These associations were virtually unchanged after adjustment for CVD risk factors. Of the novel CVD risk markers assessed, small-dense low-density lipoprotein was independently associated with increased odds of significant CIMT, with the association being similar among Blacks and Whites (odds ratio [95 % CI]: 1.7 [1.2-2.5] and 1.4 [1.0-1.8] per 1-SD higher level, respectively). Interleukin-6 was significantly associated with CAC among Blacks (1.4 [1.0-2.0]).
Conclusion:
Black race is independently associated with greater CIMT but less CAC than White race. CVD risk stratification strategies that incorporate these measures of subclinical atherosclerosis should consider race-specific algorithms.
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