title: Progression of coronary atherosclerosis in African-American patients.
abstract: BACKGROUND
  African-Americans with coronary artery disease (CAD) demonstrate worse clinical outcomes than Caucasians. While this is partly due to a lack of accessibility to established therapies, the mechanisms underlying this difference remain to be elucidated. We aimed to characterize the progression of coronary atherosclerosis in African-Americans with CAD.
  
  
  METHODS
  3,479 patients with CAD underwent serial intravascular ultrasound (IVUS) imaging to evaluate atheroma progression in 7 clinical trials of anti-atherosclerotic therapies. Risk factor control and atheroma progression were compared between African-Americans (n=170) and Caucasians (n=3,309).
  
  
  RESULTS
  African-Americans were more likely to be female (51.8% vs. 28.1%, P<0.001), have a higher body mass index (32.8±6.0 vs. 31.3±5.8 kg/m(2), P=0.002) and greater history of hypertension (85.9% vs. 78.8%, P=0.02), diabetes (41.8% vs. 30.6%, P=0.002) and stroke (12.9% vs. 3.0%, P<0.001). Despite a high use of anti-atherosclerotic medications (93% statin, 89% aspirin, 79% β-blocker, 52% ACE inhibitor), African-Americans demonstrated higher levels of LDL-C (2.4±0.7 vs. 2.2±0.7 mmol/L, P=0.006), CRP (2.9 vs. 2.0 mg/dL, P<0.001) and systolic blood pressure (133±15 vs. 129±13 mmHg, P<0.001) at follow-up. There was no significant difference in atheroma volume at baseline (189.0±82.2 vs. 191.6±83.3 mm(3), P=0.82) between two groups. Serial evaluation demonstrated a greater increase in atheroma volume in African-Americans (0.51±2.1 vs. -3.1±1.7 mm(3), P=0.01). This difference persisted with propensity matching accounting for differences in risk factor control (0.1±2.1 vs. -3.7±1.7 mm(3), P=0.02).
  
  
  CONCLUSIONS
  African-Americans with CAD achieve less optimal risk factor control and greater atheroma progression. These findings support the need for more intensive risk factor modification in African-Americans.
authors.affiliation: South Australian Health & Medical Research Institute, University of Adelaide, Adelaide, Australia;
authors.forename: Yu
authors.initials: Y
authors.lastname: Kataoka
authors.forename: Amy
authors.initials: A
authors.lastname: Hsu
authors.forename: Kathy
authors.initials: K
authors.lastname: Wolski
authors.forename: Kiyoko
authors.initials: K
authors.lastname: Uno
authors.forename: Rishi
authors.initials: R
authors.lastname: Puri
authors.forename: E Murat
authors.initials: EM
authors.lastname: Tuzcu
authors.forename: Steven E
authors.initials: SE
authors.lastname: Nissen
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Nicholls
keywords: African-American; coronary atherosclerosis; intravascular ultrasound (IVUS)