CLINICAL STUDY: CORONARY ARTERY DISEASE
Ethnic differences in coronary atherosclerosis
Matthew J. Budoff, MD*,*,
Ted P. Yang, MD*,
Robert M. Shavelle, PhD, MBA ,
Daniel H. Lamont, MBA* and
Bruce H. Brundage, MD
* Division of Cardiology, Department of Medicine, Harbor-UCLA Medical Center, Torrance, California, USA
Life Expectancy Project, San Francisco, California, USA
Bend Medical Clinic, Bend, Oregon, USA
Manuscript received May 10, 2001;
revised manuscript received October 15, 2001,
accepted November 1, 2001.
* Reprint requests and correspondence: Dr. Matthew Budoff, Division of Cardiology, Harbor-UCLA Research and Education Institute, 1124 West Carson Street, Bldg. RB-2, Torrance, California 90502-2064, USA.
mbudoff{at}rei.edu
OBJECTIVES: The study was done to evaluate whether ethnic differences exist in the prevalence of coronary artery calcification (CAC), and to determine whether differences in calcification correlate with the degree of coronary obstruction.
BACKGROUND: Electron beam tomography (EBT) can be used to quantitate the amount of CAC and assist in prognostication of future cardiac events. It is unclear whether ethnic differences in coronary mortality are related to differences in the prevalence of coronary obstruction and CAC.
METHODS: A total of 782 symptomatic subjects underwent both EBT and angiography. A 50% luminal narrowing defined an angiographic obstruction.
RESULTS: We observed substantial ethnic differences in prevalence of both CAC and angiographic stenosis. In whites (n = 453), prevalence of CAC (score >0) was 84%, and significant obstruction on angiogram was 71%. Compared with whites, blacks (n = 108) had a significantly lower prevalence of CAC (62%, p < 0.001) and angiographic disease (49%, p < 0.01). Hispanics (n = 177) also had a lower prevalence of CAC (71%, p < 0.001) and angiographic obstruction (58%, p < 0.01). Asians (n = 44) were not significantly different in regard to CAC (73%, p = 0.06) or angiographic stenosis (64%, p = 0.30). These ethnic differences remained after simultaneously controlling (by use of multiple logistic regression) for age, gender and cardiac risk factors.
CONCLUSIONS: As compared with whites, blacks and Hispanics had significantly lower prevalence of CAC and obstructive coronary disease. Ethnic differences in risk-factor profiles do not explain these differences. This study demonstrated that whites have a higher atherosclerotic burden than blacks and Hispanics, independent of risk-factor differences among symptomatic patients referred for angiography.
|
Abbreviations and Acronyms
| | ECG | | CAC | | coronary artery calcification | | CAD | | coronary artery disease | | CCS | | coronary calcium score | | CI | | confidence interval | | EBT | | electron beam tomography | | ECG | | electrocardiographic | | Hu | | Hounsfield units | | MI | | myocardial infarction | | OR | | odds ratio |
|
This article has been cited by other articles:
|
|
|
|
 
R. P. Vivo, S. R. Krim, C. Cevik, and R. M. Witteles
Heart failure in hispanics.
J. Am. Coll. Cardiol.,
April 7, 2009;
53(14):
1167 - 1175.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Ruan, W. Chen, S. R. Srinivasan, M. Sun, H. Wang, A. Toprak, and G. S. Berenson
Correlates of Common Carotid Artery Lumen Diameter in Black and White Younger Adults: The Bogalusa Heart Study
Stroke,
March 1, 2009;
40(3):
702 - 707.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. A. Albert
Heart Failure in the Urban African Enclave of Soweto: A Case Study of Contemporary Epidemiological Transition in the Developing World
Circulation,
December 2, 2008;
118(23):
2323 - 2325.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S.-s. Jiang, L. Lv, C. P. Juergens, S.-l. Chen, D.-j. Xu, and Z.-y. Huang
Racial Differences in Coronary Artery Lesions: A Comparison of Coronary Artery Lesions Between Mainland Chinese and Australian Patients
Angiology,
August 1, 2008;
59(4):
442 - 447.
[Abstract]
[PDF]
|
|
|
|
|
|
|
L. J. Shaw, R. E. Shaw, C. N. B. Merz, R. G. Brindis, L. W. Klein, B. Nallamothu, P. S. Douglas, R. J. Krone, C. R. McKay, P. C. Block, et al.
Impact of Ethnicity and Gender Differences on Angiographic Coronary Artery Disease Prevalence and In-Hospital Mortality in the American College of Cardiology-National Cardiovascular Data Registry
Circulation,
April 8, 2008;
117(14):
1787 - 1801.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Nasir, L. J. Shaw, S. T. Liu, S. R. Weinstein, T. R. Mosler, P. R. Flores, F. R. Flores, P. Raggi, D. S. Berman, R. S. Blumenthal, et al.
Ethnic Differences in the Prognostic Value of Coronary Artery Calcification for All-Cause Mortality
J. Am. Coll. Cardiol.,
September 4, 2007;
50(10):
953 - 960.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. M. Loria, K. Liu, C. E. Lewis, S. B. Hulley, S. Sidney, P. J. Schreiner, O. D. Williams, D. E. Bild, and R. Detrano
Early Adult Risk Factor Levels and Subsequent Coronary Artery Calcification: The CARDIA Study
J. Am. Coll. Cardiol.,
May 22, 2007;
49(20):
2013 - 2020.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Greenland, R. O. Bonow, B. H. Brundage, M. J. Budoff, M. J. Eisenberg, S. M. Grundy, M. S. Lauer, W. S. Post, P. Raggi, R. F. Redberg, et al.
ACCF/AHA 2007 Clinical Expert Consensus Document on Coronary Artery Calcium Scoring By Computed Tomography in Global Cardiovascular Risk Assessment and in Evaluation of Patients With Chest Pain: A Report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography) Developed in Collaboration With the Society of Atherosclerosis Imaging and Prevention and the Society of Cardiovascular Computed Tomography
J. Am. Coll. Cardiol.,
January 23, 2007;
49(3):
378 - 402.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. R. Crouse III
Thematic review series: Patient-Oriented Research. Imaging atherosclerosis: state of the art
J. Lipid Res.,
August 1, 2006;
47(8):
1677 - 1699.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. T. Lewis, S. A. Everson-Rose, L. H. Powell, K. A. Matthews, C. Brown, K. Karavolos, K. Sutton-Tyrrell, E. Jacobs, and D. Wesley
Chronic Exposure to Everyday Discrimination and Coronary Artery Calcification in African-American Women: The SWAN Heart Study
Psychosom Med,
May 1, 2006;
68(3):
362 - 368.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Zindrou, K. M. Taylor, and J. P. Bagger
Coronary artery size and disease in UK South Asian and Caucasian men.
Eur. J. Cardiothorac. Surg.,
April 1, 2006;
29(4):
492 - 495.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Iribarren, I. Tolstykh, C. P. Somkin, L. M. Ackerson, T. T. Brown, R. Scheffler, L. Syme, and I. Kawachi
Sex and Racial/Ethnic Disparities in Outcomes After Acute Myocardial Infarction: A Cohort Study Among Members of a Large Integrated Health Care Delivery System in Northern California
Arch Intern Med,
October 10, 2005;
165(18):
2105 - 2113.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. V. Diez Roux, R. Detrano, S. Jackson, D. R. Jacobs Jr, P. J. Schreiner, S. Shea, and M. Szklo
Acculturation and Socioeconomic Position as Predictors of Coronary Calcification in a Multiethnic Sample
Circulation,
September 13, 2005;
112(11):
1557 - 1565.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Y. Arad, K. J. Goodman, M. Roth, D. Newstein, and A. D. Guerci
Coronary Calcification, Coronary Disease Risk Factors, C-Reactive Protein, and Atherosclerotic Cardiovascular Disease Events: The St. Francis Heart Study
J. Am. Coll. Cardiol.,
July 5, 2005;
46(1):
158 - 165.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. J. Shaw, R. C. Hendel, M. Cerquiera, J. H. Mieres, N. Alazraki, E. Krawczynska, S. Borges-Neto, J. Maddahi, and C. N. Bairey Merz
Ethnic Differences in the Prognostic Value of Stress Technetium-99m Tetrofosmin Gated Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging
J. Am. Coll. Cardiol.,
May 3, 2005;
45(9):
1494 - 1504.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. E. Bild, R. Detrano, D. Peterson, A. Guerci, K. Liu, E. Shahar, P. Ouyang, S. Jackson, and M. F. Saad
Ethnic Differences in Coronary Calcification: The Multi-Ethnic Study of Atherosclerosis (MESA)
Circulation,
March 15, 2005;
111(10):
1313 - 1320.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Jain, R. Peshock, D. K. McGuire, D. Willett, Z. Yu, G. L. Vega, R. Guerra, H. H. Hobbs, S. M. Grundy, and the Dallas Heart Study Investigators
African Americans and Caucasians have a similar prevalence of coronary calcium in the Dallas Heart Study
J. Am. Coll. Cardiol.,
September 1, 2004;
44(5):
1011 - 1017.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. D. Reaven and J. Sacks
Reduced Coronary Artery and Abdominal Aortic Calcification in Hispanics With Type 2 Diabetes
Diabetes Care,
May 1, 2004;
27(5):
1115 - 1120.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. P. Reilly, M. L. Wolfe, A. R. Localio, and D. J. Rader
C-Reactive Protein and Coronary Artery Calcification: The Study of Inherited Risk of Coronary Atherosclerosis (SIRCA)
Arterioscler. Thromb. Vasc. Biol.,
October 1, 2003;
23(10):
1851 - 1856.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. P. Burke, R. Virmani, Z. Galis, C. C. Haudenschild, and J. E. Muller
Task force #2--what is the pathologic basis for new atherosclerosis imaging techniques?
J. Am. Coll. Cardiol.,
June 4, 2003;
41(11):
1874 - 1886.
[Full Text]
[PDF]
|
|
|
|
