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Disparities among Black and White patients in plaque burden and composition and long-term impact
Rebecca Torguson1, Gary S Mintz2, Carlo Di Mario3
1The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Insights
Black patients exhibit greater plaque burden and lipid content, increasing their risk for cardiac events. Both high lipid burden and Black race independently predict major adverse cardiac events within two years.
Area of Science:
- Cardiovascular Medicine
- Medical Imaging
- Health Disparities
Background:
- Black patients undergoing cardiac catheterization have higher risk factors and poorer long-term outcomes.
- The Lipid Rich Plaque (LRP) study investigated plaque burden and composition differences between Black and White patients.
Purpose of the Study:
- To quantify and compare plaque burden and composition in Black versus White patients.
- To assess the association between plaque characteristics, race, and adverse cardiac events.
Main Methods:
- Sub-analysis of the LRP study including 1346 patients (182 Black).
- Near-infrared spectroscopy/intravascular ultrasound (NIRS-IVUS) used to quantify lipidic content (maxLCBI4mm) in non-culprit lesions.
- Non-culprit major adverse cardiac events (NC-MACE) tracked for 2 years.
Main Results:
- Black patients were more likely female, had higher risk factors, and presented more acutely.
- Black patients had significantly higher maxLCBI4mm (46.7% vs 30.6%) and greater plaque burden.
- High maxLCBI4mm (HR: 2.37) and Black race (HR: 2.8) independently predicted NC-MACE at 2 years.
Conclusions:
- Black patients present with more lipid-rich plaques and higher plaque burden.
- Both elevated lipidic burden and Black race are independent predictors of 2-year NC-MACE.
Background:
Black patients presenting to the catheterization laboratory have more risk factors and worse long-term outcomes. This sub-analysis of the Lipid Rich Plaque (LRP) study quantifies the plaque burden and composition of Black vs White patients and associated outcomes.
Methods:
Patients with a singular, self-reported race presenting for cardiac catheterization were enrolled if near-infrared spectroscopy/intravascular ultrasound (NIRS-IVUS) imaging of non-stented, non-culprit (NC) vessels was performed. Lipidic content was quantified at the 4-mm region with maximum Lipid Core Burden Index (maxLCBI4mm). NC major adverse cardiac events (NC-MACE) were defined as: cardiac death, cardiac arrest, non-fatal myocardial infarction, acute coronary syndrome, revascularization, and hospital readmission for angina with >20 % disease progression through 2 years.
Results:
Among 1346 patients with a singular, self-reported race, 182 were Black. Black vs White patients were more likely to be female, had higher rates of traditional risk factors, and were more likely to present acutely. Both patients and segments were more likely to have maxLCBI4mm > 400 (46.7 % vs 30.6 %, p < 0.001, respectively; 15.5 % vs 8.9 %, p < 0.001, respectively). Vessel size and plaque burden were larger for Black vs White patients. At 2 years, maxLCBI4mm > 400 and Black race were independently predictive of NC-MACE (hazard ratio [HR] maxLCBI4mm > 400: 2.37 [95 % confidence interval (CI) 1.50-3.76, p < 0.001], Black race: 2.8 [95 % CI 1.27-3.42, p = 0.004], pinteraction = 0.137).
Conclusions:
Compared to White patients, Black patients had more lipid-rich plaques with greater plaque burden. Both high lipidic burden and Black race were independently predictive of NC-MACE within 2 years.
Clinical Trial Registration:
https://clinicaltrials.gov/ct2/show/NCT02033694, NCT02033694.
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