Race Differences in High-Grade Carotid Artery Stenosis

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.