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J Am Coll Cardiol, 2003; 41:39-44 © 2003 by the American College of Cardiology Foundation |
,*
* Department of Medicine, Walter Reed Army Medical Center, Washington, DC, USA
Cardiology, Walter Reed Army Medical Center, Washington, DC, USA
Radiology, Walter Reed Army Medical Center, Washington, DC, USA
Manuscript received February 6, 2002; revised manuscript received June 13, 2002, accepted June 26, 2002.
* Reprint requests and correspondence: Dr. Allen J. Taylor, Cardiology Service, Walter Reed Army Medical Center, 6900 Georgia Avenue NW, Building 2, Room 4A, Washington, DC 20307-5001, USA.
allen.taylor{at}na.amedd.army.mil
OBJECTIVES: We studied the relationship between coronary artery calcium (CAC) and race in asymptomatic, active-duty personnel in the Prospective Army Coronary Calcium (PACC) project.
BACKGROUND: Valid cardiovascular risk assessments in black Americans using coronary artery computed tomography (coronary CT) require the generalizability of population-based CAC score distributions derived from primarily white patient populations.
METHODS: Among 1,000 consecutive participants (mean age, 42 ± 2 years; range, 40 to 45 years), 999 participants underwent coronary CT and indicated a specific racial affiliation. This included white, non-Hispanic in 699 (69.9%) participants and black, non-Hispanic in 194 (19.4%) participants. Univariate associations between race and cardiovascular risk variables were entered into a logistic regression model for CAC that also controlled for socioeconomic status and education.
RESULTS: Coronary artery calcium was nearly twice as prevalent in white (19.2%) than in black participants (10.3%) (p = 0.004). Black individuals had a threefold greater prevalence of hypertension, left ventricular hypertrophy, ST-T-wave abnormalities, and current cigarette smoking. Black subjects also had significantly greater blood pressure, high-density lipoprotein cholesterol, glycosylated hemoglobin, lipoprotein(a) and fibrinogen levels, and lower triglyceride levels and waist girth than white subjects. After adjustment for these differences, and socioeconomic adjusters, black individuals were 39% as likely to have any CAC present (odds ratio, 0.39; 95% confidence interval, 0.20 to 0.78; p = 0.007).
CONCLUSIONS: Despite a worse cardiovascular risk profile, black Americans have significantly less CAC than white Americans. The use of coronary CT as an accurate risk prediction tool in black Americans will require ethnic-specific data on the presence and severity of CAC.
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