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Association of Race and Major Adverse Cardiac Events (MACE): The Atherosclerosis Risk in Communities (ARIC) Cohort
Ericha G Franey1,2, Donna Kritz-Silverstein2, Erin L Richard1,2
1Graduate School of Public Health, San Diego State University, San Diego, CA, USA.
Background And Aims:
To evaluate the association of self-reported race with major adverse cardiac events (MACE) and modification of this association by paraoxonase gene (PON1, PON2, and PON3) single nucleotide polymorphisms (SNPs).
Methods:
Included in this longitudinal study were 12,770 black or white participants from the Atherosclerosis Risk in Communities (ARIC) cohort who completed a baseline visit (1987-1989) with PON genotyping. Demographic, behavioral, and health information was obtained at baseline. MACE was defined as first occurrence of myocardial infarction, stroke, or CHD-related death through 2004. Cox proportional hazards regression was used to evaluate the association between race and MACE after adjustment for age, gender, and other demographic and cardiovascular risk factors such as diabetes and hypertension. Modification of the association between PON SNPs and MACE was also assessed.
Results:
Blacks comprised 24.6% of the ARIC cohort; overall, 14.0% of participants developed MACE. Compared with whites, blacks had 1.24 times greater hazard of MACE (OR = 1.24,95%CI = 1.10,1.39) than whites after adjusting for age, gender, BMI, cigarette and alcohol use, educational and marital status, and aspirin use. This association became nonsignificant after further adjustment for high cholesterol, diabetes, and hypertension. None of the evaluated SNPs met the significance level (p < 0.001) after Bonferroni correction for multiple comparisons.
Conclusions:
No association between race and MACE was identified after adjusting for high cholesterol, diabetes, and hypertension, suggesting that comorbidities are major determinants of MACE; medical intervention with focus on lifestyle and health management could ameliorate the development of MACE. Further studies are needed to confirm this observation.
Insights
Self-reported race was not associated with major adverse cardiac events (MACE) after accounting for comorbidities like high cholesterol, diabetes, and hypertension. These health conditions, rather than race, appear to be key drivers of MACE development.
Area of Science:
- Cardiovascular Epidemiology
- Genetics
- Public Health
Background:
- Investigating the link between self-reported race and cardiovascular disease risk is crucial for understanding health disparities.
- The role of paraoxonase (PON) gene single nucleotide polymorphisms (SNPs) in modifying this association requires further exploration.
Purpose of the Study:
- To determine the association between self-reported race and major adverse cardiac events (MACE).
- To assess if paraoxonase gene (PON1, PON2, PON3) SNPs modify the relationship between race and MACE.
Main Methods:
- A longitudinal study of 12,770 Black and White participants from the Atherosclerosis Risk in Communities (ARIC) cohort.
- Cox proportional hazards regression was used to analyze MACE (myocardial infarction, stroke, CHD death) and its association with race, adjusting for various demographic, behavioral, and clinical factors.
- PON gene genotyping was performed, and the modification of the race-MACE association by specific SNPs was assessed.
Main Results:
- Initially, Black participants showed a higher hazard of MACE compared to White participants (Hazard Ratio=1.24).
- This association became non-significant after further adjustment for high cholesterol, diabetes, and hypertension.
- None of the evaluated PON gene SNPs reached statistical significance after Bonferroni correction.
Conclusions:
- Comorbidities such as high cholesterol, diabetes, and hypertension are significant determinants of MACE, overshadowing the influence of race.
- Lifestyle and health management interventions targeting these comorbidities could mitigate MACE development.
- Further research is recommended to validate these findings.
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