Race Differences in High-Grade Carotid Artery Stenosis
Brajesh K Lal1, James F Meschia2, Thomas G Brott2
1University of Maryland School of Medicine, Baltimore VA Medical Center (B.K.L., A.L.).
Insights
Black and Hispanic individuals have lower rates of high-grade carotid stenosis, despite higher cardiovascular risk. This finding may explain the underuse of carotid revascularization procedures in these populations.
Area of Science:
- Vascular Medicine
- Epidemiology
- Public Health
Background:
- Blacks and Hispanics face higher stroke incidence and adverse cardiovascular risk factors compared to Whites.
- Carotid artery revascularization is less frequently performed in Black and Hispanic populations.
Purpose of the Study:
- To assess racial and ethnic differences in the prevalence of high-grade carotid stenosis (≥70% diameter reduction).
Main Methods:
- A cross-sectional study analyzed data from 6,130,481 individuals screened for vascular disease from 2005 to 2019.
- High-grade stenosis was defined by carotid ultrasound peak systolic velocity ≥230 cm/s.
- Poisson regression was used to assess race/ethnic differences, with prevalence estimates applied to US Census data.
Main Results:
- The prevalence of high-grade carotid stenosis increased with age across all groups.
- Blacks and Hispanics generally showed lower prevalence compared to Whites (e.g., men aged 55-65: RR 0.40 for Blacks, 0.61 for Hispanics vs. Whites).
- Native Americans had a higher prevalence (e.g., men aged 55-65: RR 1.53 vs. Whites). An estimated 327,721 individuals have high-grade stenosis, with 7% Black, 7% Hispanic, and 43% women.
Conclusions:
- Despite adverse cardiovascular risk profiles, Black and Hispanic individuals exhibited a lower prevalence of high-grade carotid artery stenosis than Whites.
- This lower prevalence may contribute to the reduced utilization of carotid revascularization procedures in these minority groups.
Background And Purpose:
Despite a higher incidence of stroke and a more adverse cardiovascular risk factor profile in Blacks and Hispanics compared with Whites, carotid artery revascularization is performed less frequently among these subpopulations. We assessed racial differences in high-grade (≥70% diameter-reducing) carotid stenosis.
Methods:
Consecutive clients in a Nationwide Life Line for-Profit Service to screen for vascular disease, 2005 to 2019 were evaluated in a cross-sectional study. The prevalence of high-grade stenosis, defined by a carotid ultrasound peak systolic velocity of ≥230 cm/s, was assessed. Participants self-identified as White, Black, Hispanic, Asian, Native American, or other. Race/ethnic differences were assessed using Poisson regression. The number of individuals in the United States with high-grade stenosis was estimated by applying prevalence estimates to 2015 US Census population estimates.
Results:
The prevalence of high-grade carotid stenosis was estimated in 6 130 481 individuals. The prevalence of high-grade stenosis was higher with increasing age in all race-sex strata. Generally, Blacks and Hispanics had a lower prevalence of high-grade stenosis compared with Whites, while Native Americans had a higher prevalence. For example, for men aged 55 to 65, the relative risk of stenosis compared with Whites was 0.40 (95% CI, 0.29–0.55) and 0.61 (95% CI, 0.46–0.81) for Blacks and Hispanics, respectively; and 1.53 (95% CI, 1.12–2.10) for Native Americans. When these prevalence estimates were applied to the Census estimates of the US population, an estimated 327 721 individuals have high-grade stenosis, of whom 7% are Black, 7% Hispanic, and 43% women.
Conclusions:
Despite their having a more adverse cardiovascular risk profile, there was a lower prevalence of high-grade carotid artery stenosis for both the Black and Hispanic relative to the White clients. This lower prevalence of high-grade stenosis is a potential contributor to the lower use of carotid revascularization procedures in these minority populations.
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