Ethnic differences of the presence and severity of coronary atherosclerosis.
BACKGROUND
Although cardiovascular risk factor levels are substantially different in Caucasians, African-American, Hispanics, and Asians, the relative rates of coronary heart disease in these groups are not consistent with these differences. The objective of the study is to assess the differences in the prevalence and severity of coronary artery calcification, as a measure of atherosclerosis, in these different ethnic groups.


METHODS
Electron-beam tomography was performed in 16,560 asymptomatic men and women (Asians=1336, African-Americans=610, Hispanics=1256) aged >or=35 years referred by their physician for cardiovascular risk evaluation. The study population encompassed 70% males, aged 52+/-8 years.


RESULTS
Caucasians were more likely to present with dyslipidemia (p<0.0001), while African-Americans and Hispanics had a higher prevalence of smoking, diabetes, and hypertension (all p<0.001). After adjustment for age, gender, risk factors, and treatment for hypercholesterolemia, compared with Caucasians, the relative risks for men having coronary calcification were 0.64 (95% CI: 0.48-0.86) in African-Americans, 0.88 (95% CI: 0.67-1.15) in Hispanics, and 0.66 (95% CI: 0.55-0.80) in Asians. After similar adjustments, the relative risks for women having coronary calcification, were 1.58 (95% CI: 1.13-2.19) for African-Americans, 0.84 (95% CI: 0.66-1.06) in Hispanics, and 0.71 (95% CI: 0.56-0.89) in Asian women. After adjusting for age and risk factors using multivariable analysis, African-American men were least likely to have any coronary calcium while African-American women had significantly higher OR of any calcification. Asian men and women had significantly lower OR of any calcification. There was no significant difference in prevalence or severity of atherosclerosis between Hispanics and Caucasians, in men or women.


CONCLUSIONS
Our study results demonstrate significant difference in the presence as well as severity of calcification according to ethnicity, independent of atherosclerotic risk factors. Results from this study (physician referred) closely parallel the results from MESA (population based, measured risk factors). Ethnic specific data on the predictive value of differing coronary calcium scores are needed.
Budoff
Matthew J
MJ
Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, 1124 W Carson Street, Bldg RB-2, Torrance, CA, USA. budoff@ucla.edu
Nasir
Khurram
K
Mao
Songshou
S
Tseng
Philip H
PH
Chau
Alex
A
Liu
Sandy T
ST
Flores
Ferdinand
F
Blumenthal
Roger S
RS
D001741:Black or African American / Q000706:statistics & numerical data; D044466:Asian People / Q000706:statistics & numerical data; D002114:Calcinosis / Q000208:ethnology; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000208:ethnology*; D003920:Diabetes Mellitus / Q000208:ethnology; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D006937:Hypercholesterolemia / Q000208:ethnology; D006973:Hypertension / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D044469:Racial Groups / Q000706:statistics & numerical data*; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D014057:Tomography, X-Ray Computed; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data