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Association of Race and Ethnicity With Obstructive Coronary Artery Disease
Jasjit Rooprai1, Feng Qiu1, Joan Porter1
1ICES, Toronto, Ontario, Canada.
Insights
South Asian and East Asian patients with coronary artery disease (CAD) have higher odds of obstructive CAD compared to White patients. This highlights the need to incorporate race and ethnicity into CAD risk prediction models.
Area of Science:
- Cardiology
- Health Disparities
- Medical Research
Background:
- Patient selection for coronary angiography in stable coronary artery disease (CAD) relies on pretest probability of obstructive CAD.
- Limited data exists on racial and ethnic variations in CAD prevalence and severity.
Purpose of the Study:
- To investigate the association between race, ethnicity, and the presence of coronary obstruction in patients with stable CAD.
Main Methods:
- Analysis of 71,199 patients undergoing first coronary angiography in Ontario, Canada (2012-2019).
- Race and ethnicity data were physician-identified.
- Obstructive CAD defined as left main stenosis ≥50% or major epicardial vessel stenosis ≥70%.
- Multivariable logistic regression used to assess independent associations.
Main Results:
- South Asian (SA) patients (14.0%) were youngest and most likely to have obstructive CAD (46.9%), compared to East Asian (EA) (43.0%) and White patients (37.9%).
- SA patients had a 67% higher adjusted odds of obstructive CAD versus White patients (OR 1.67).
- EA patients also showed increased adjusted odds of obstructive CAD compared to White patients (OR 1.40).
- SA patients exhibited the highest prevalence of 3-vessel CAD (13.4%).
Conclusions:
- Younger South Asian patients presented with a higher likelihood of obstructive CAD.
- Race and ethnicity are significant factors associated with obstructive CAD.
- Integrating racial and ethnic data into risk prediction tools may enhance the detection of coronary obstruction.
Background:
Appropriate selection of patients with stable coronary artery disease (CAD) for coronary angiography is dependent on the pretest probability of obstructive CAD; however, little is known about the potential differences in CAD by race and ethnic groups.
Objectives:
The purpose of this study was to evaluate the association of race and ethnicity with coronary obstruction in stable CAD.
Methods:
We evaluated first coronary angiography for CAD evaluation between 2012 and 2019 in Ontario, Canada. Race and ethnicity were identified by physicians. The main outcome was the rate of obstructive CAD (left main stenosis ≥50% or major epicardial vessel stenosis ≥70%). Multivariable logistic regression analyses evaluated the independent association of race and ethnicity with CAD.
Results:
Among 71,199 CAD patients, 14.0% were South Asian (SA), 4.4% were East Asian (EA), and 58,131 were White patients. SA patients were the youngest at 60.9 years vs 62.4 years for EA patients and 65.1 years for White patients but were most likely to have obstructive CAD (46.9%) (EA 43.0% and White patients 37.9%). SA patients had the highest prevalence of 3-vessel CAD at 13.4% (vs 12.5% in EA and 7.7% in White patients). The adjusted odds ratio was 67% higher (1.67; 95% CI: 1.59 to 1.75) for having obstructive CAD in SA patients than that in White patients. EA patients also had significantly increased adjusted odds of obstructive CAD compared with White patients (1.40; 95% CI: 1.29-1.52).
Conclusions:
SA patients were younger at presentation but had the highest adjusted odds of obstructive CAD. Incorporation of race and ethnicity information may improve risk-prediction tools for detection of coronary obstruction.
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