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Racial differences in coronary calcium prevalence among high-risk adults
W Tang1, R C Detrano, O S Brezden
1Saint John's Cardiovascular Research Center, Torrance, California, USA.
Insights
African Americans have lower coronary calcium prevalence than Caucasians or Asian Americans, despite similar coronary artery disease risk. This finding highlights ethnic disparities in cardiovascular health.
Area of Science:
- Cardiology
- Radiology
- Public Health
Background:
- Coronary calcium detection aids in cardiovascular risk assessment.
- Ethnic variations in cardiovascular disease prevalence are well-documented.
- Asymptomatic individuals represent a critical population for primary prevention strategies.
Purpose of the Study:
- To investigate ethnic differences in coronary calcium prevalence among asymptomatic high-risk adults.
- To determine if observed ethnic disparities in coronary calcium correlate with coronary artery disease (CAD) events.
- To assess the utility of digital subtraction fluoroscopy in detecting coronary calcium across diverse ethnic groups.
Main Methods:
- A cohort of 1,461 asymptomatic high-risk adults underwent coronary calcium assessment using digital subtraction fluoroscopy and cinefluoroscopy.
- Ethnicity, risk factor data, and prior myocardial infarction history were recorded for all participants.
- Follow-up for coronary artery disease events was conducted over approximately 20 months.
Main Results:
- Overall coronary calcium prevalence was 58%, with significant ethnic variations: 36% in African Americans, 60% in Caucasians, and 60% in Asian Americans (p < 0.0001).
- These ethnic differences persisted after adjusting for age, gender, and other cardiovascular risk factors (p = 0.003).
- African Americans experienced a higher rate of coronary artery disease events (13%) compared to Caucasians (6%) and Asian Americans (5%) (p = 0.04) during follow-up.
Conclusions:
- African Americans exhibit a significantly lower prevalence of coronary calcium compared to Caucasian and Asian American individuals.
- The observed ethnic differences in coronary calcium prevalence are not explained by variations in traditional cardiovascular risk factors.
- These findings suggest potential underlying biological or environmental factors contributing to ethnic disparities in cardiovascular health and disease progression.
Abstract:
A total of 1,461 asymptomatic high-risk adult subjects were studied with digital subtraction fluoroscopy and conventional cinefluoroscopy to detect coronary calcium. Ethnicity and risk factor data were recorded. No subject had a history or electrocardiographic evidence of prior myocardial infarction. The prevalence of coronary calcium by digital subtraction fluoroscopy was high (58%). Substantial ethnic differences in prevalence were noted: 36% of African American subjects, 60% of Caucasian subjects, and 60% of Asian American subjects had definite radiographic evidence of coronary calcium. The difference in prevalence between African American and other subjects was significant (p < 0.0001) by chi-square test for all 3 races. These differences persisted in the unsubtracted cinefluoroscopic images (p < 0.0001) and after controlling for age, gender, and other risk factors (p = 0.003). After 20 +/- 11 months of follow-up, African Americans had more coronary artery disease events (13%) than Caucasians (6%) or Asian Americans (5%) (p = 0.04). Thus, African Americans have a significantly lower prevalence of coronary calcium than do Caucasians or Asian Americans. Based on the follow-up results, these differences in prevalence are not explained by differences in coronary artery disease risk.