title: Ethnic differences in the prognostic value of coronary artery calcification for all-cause mortality.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the prognostic value of coronary artery calcium (CAC), a known marker of subclinical atherosclerosis, in a large, ethnically diverse cohort of 14,812 patients for the prediction of all-cause mortality.
  
  
  BACKGROUND
  Disparities in case fatality rates for heart disease among ethnic groups are well known. In 2001, rates of death from heart disease were 30% higher among African Americans (AA) than non-Hispanic whites (NHW). Some of this variability may be due to differing pathophysiological mechanisms and effects of underlying atherosclerosis.
  
  
  METHODS
  Ten-year death rates from all causes (total deaths = 505) were compared using risk-adjusted Cox proportional hazards models in AA (n = 637), Hispanic (HS, n = 1,334), Asian (AS, n = 1,065), and NHW (n = 11,776) populations.
  
  
  RESULTS
  Ethnic minority patients were generally younger (0.3 to 4 years), more often persons with diabetes (p < 0.0001), hypertensive (p < 0.0001), and female (p < 0.0001). The prevalence of CAC scores > or =100 was highest in NHW (31%) and lowest for HS (18%) (p < 0.0001). Overall survival was 96%, 93%, and 92% for AS, NHW, and HS, respectively, as compared with 83% for AA (p < 0.0001). When comparing prognosis by CAC scores in ethnic minorities as compared with NHW, relative risk ratios were highest for AA with CAC scores > or =400 exceeding 16.1 (p < 0.0001). Hispanics with CAC scores > or =400 had relative risk ratios from 7.9 to 9.0, whereas AS with CAC scores > or =1,000 had relative risk ratios 6.6-fold higher than NHW (p < 0.0001).
  
  
  CONCLUSIONS
  Consistent with population evidence, AA with increasing burden of subclinical coronary artery disease were the highest-risk ethnic minority population. These data support a growing body of evidence noting substantial differences in cardiovascular risk by ethnicity.
authors.affiliation: Cardiac MRI PET CT Program, Massachusetts General Hospital Boston, Harvard School of Medicine, Boston, Massachusetts, USA.
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
authors.forename: Leslee J
authors.initials: LJ
authors.lastname: Shaw
authors.forename: Sandy T
authors.initials: ST
authors.lastname: Liu
authors.forename: Steven R
authors.initials: SR
authors.lastname: Weinstein
authors.forename: Tristen R
authors.initials: TR
authors.lastname: Mosler
authors.forename: Phillip R
authors.initials: PR
authors.lastname: Flores
authors.forename: Ferdinand R
authors.initials: FR
authors.lastname: Flores
authors.forename: Paolo
authors.initials: P
authors.lastname: Raggi
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Berman
authors.forename: Roger S
authors.initials: RS
authors.lastname: Blumenthal
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D001213:Asian / Q000706:statistics & numerical data; D002114:Calcinosis; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000208:ethnology* / Q000401:mortality; D003331:Coronary Vessels / Q000737:chemistry* / Q000473:pathology; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data