TY - JOUR
T1 - Ethnic Differences in the Prognostic Value of Coronary Artery Calcification for All-Cause Mortality
AU - Nasir, Khurram
AU - Shaw, Leslee J.
AU - Liu, Sandy T.
AU - Weinstein, Steven R.
AU - Mosler, Tristen R.
AU - Flores, Phillip R.
AU - Flores, Ferdinand R.
AU - Raggi, Paolo
AU - Berman, Daniel S.
AU - Blumenthal, Roger S.
AU - Budoff, Matthew J.
PY - 2007/9/4
Y1 - 2007/9/4
N2 - Objectives: 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 ≥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 ≥400 exceeding 16.1 (p < 0.0001). Hispanics with CAC scores ≥400 had relative risk ratios from 7.9 to 9.0, whereas AS with CAC scores ≥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.
AB - Objectives: 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 ≥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 ≥400 exceeding 16.1 (p < 0.0001). Hispanics with CAC scores ≥400 had relative risk ratios from 7.9 to 9.0, whereas AS with CAC scores ≥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.
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U2 - 10.1016/j.jacc.2007.03.066
DO - 10.1016/j.jacc.2007.03.066
M3 - Article
C2 - 17765122
AN - SCOPUS:34548190955
SN - 0735-1097
VL - 50
SP - 953
EP - 960
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 10
ER -