CLINICAL STUDY: CHRONIC CORONARY ATHEROSCLEROSIS
The prevalence and severity of coronaryartery calcification on coronary arterycomputed tomography in black and white subjects
Timothy C. Lee, MD ,
Patrick G. O’Malley, MD, MPH*,
Irwin Feuerstein, MD and
Allen J. Taylor, MD,*
* 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.
|
Abbreviations and Acronyms
| | BMI | | body mass index | | CAC | | coronary artery calcium | | CARDIA | | Coronary Artery Risk Development In young Adults study | | coronary CT | | coronary artery computed tomography | | PACC | | Prospective Army Coronary Calcium project |
|
This article has been cited by other articles:
|
|
|
|
 
J. H. Ix, M. A. Allison, J. O. Denenberg, M. Cushman, and M. H. Criqui
Novel cardiovascular risk factors do not completely explain the higher prevalence of peripheral arterial disease among African Americans. The San Diego Population Study.
J. Am. Coll. Cardiol.,
June 17, 2008;
51(24):
2347 - 2354.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. P Burdon, A. B Lehtinen, C. D Langefeld, J. J. Carr, S. S Rich, B. I Freedman, D. Herrington, and D. W Bowden
Genetic analysis of the soluble epoxide hydrolase gene, EPHX2, in subclinical cardiovascular disease in the Diabetes Heart Study
Diabetes and Vascular Disease Research,
June 1, 2008;
5(2):
128 - 134.
[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]
|
|
|
|
|
|
|
R. Detrano, A. D. Guerci, J. J. Carr, D. E. Bild, G. Burke, A. R. Folsom, K. Liu, S. Shea, M. Szklo, D. A. Bluemke, et al.
Coronary Calcium as a Predictor of Coronary Events in Four Racial or Ethnic Groups
N. Engl. J. Med.,
March 27, 2008;
358(13):
1336 - 1345.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Shroff, A. Kerchner, M. Maifeld, E. J. R. Van Beek, D. Jagasia, and A. Dokras
Young Obese Women with Polycystic Ovary Syndrome Have Evidence of Early Coronary Atherosclerosis
J. Clin. Endocrinol. Metab.,
December 1, 2007;
92(12):
4609 - 4614.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. A. Rumberger
The Ethnic Rosetta Stone: Translating Risk Factors, Plaque Scores, and Mortality
J. Am. Coll. Cardiol.,
September 4, 2007;
50(10):
961 - 963.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Hravnak, J. Whittle, M. E. Kelley, S. Sereika, C. B. Good, S. A. Ibrahim, and J. Conigliaro
Symptom Expression in Coronary Heart Disease and Revascularization Recommendations for Black and White Patients
Am J Public Health,
September 1, 2007;
97(9):
1701 - 1708.
[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]
|
|
|
|
|
|
|
I. J. Kullo, G. Li, L. F. Bielak, K. R. Bailey, P. F. Sheedy II, P. A. Peyser, S. T. Turner, and S. L. R. Kardia
Association of Plasma Homocysteine With Coronary Artery Calcification in Different Categories of Coronary Heart Disease Risk
Mayo Clin. Proc.,
February 1, 2006;
81(2):
177 - 182.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. R. Carnethon, A. G. Bertoni, S. Shea, P. Greenland, H. Ni, D. R. Jacobs Jr, M. Saad, and K. Liu
Racial/Ethnic Differences in Subclinical Atherosclerosis Among Adults With Diabetes: The Multiethnic Study of Atherosclerosis
Diabetes Care,
November 1, 2005;
28(11):
2768 - 2770.
[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]
|
|
|
|
|
|
|
B. I. Freedman, C. D. Langefeld, K. K. Lohman, D. W. Bowden, J. J. Carr, S. S. Rich, and L. E. Wagenknecht
Relationship between Albuminuria and Cardiovascular Disease in Type 2 Diabetes
J. Am. Soc. Nephrol.,
July 1, 2005;
16(7):
2156 - 2161.
[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. Saam, J.M. Cai, Y.Q. Cai, N.Y. An, A. Kampschulte, D. Xu, W.S. Kerwin, N. Takaya, N.L. Polissar, T.S. Hatsukami, et al.
Carotid Plaque Composition Differs Between Ethno-Racial Groups: An MRI Pilot Study Comparing Mainland Chinese and American Caucasian Patients
Arterioscler Thromb Vasc Biol,
March 1, 2005;
25(3):
611 - 616.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. J. Kullo, K. R. Bailey, L. F. Bielak, P. F. Sheedy II, G. G. Klee, S. L. Kardia, P. A. Peyser, E. Boerwinkle, and S. T. Turner
Lack of Association Between Lipoprotein(a) and Coronary Artery Calcification in the Genetic Epidemiology Network of Arteriopathy (GENOA) Study
Mayo Clin. Proc.,
October 1, 2004;
79(10):
1258 - 1263.
[Abstract]
[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]
|
|
|
|
|
|
|
U. J. Schoepf, C. R. Becker, B. M. Ohnesorge, and E. K. Yucel
CT of Coronary Artery Disease
Radiology,
July 1, 2004;
232(1):
18 - 37.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. B. J. Mancini, B. Dahlof, and J. Diez
Surrogate Markers for Cardiovascular Disease: Structural Markers
Circulation,
June 29, 2004;
109(25_suppl_1):
IV-22 - IV-30.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Fornage, E. Boerwinkle, P. A. Doris, D. Jacobs, K. Liu, and N. D. Wong
Polymorphism of the Soluble Epoxide Hydrolase Is Associated With Coronary Artery Calcification in African-American Subjects: The Coronary Artery Risk Development In Young Adults (CARDIA) Study
Circulation,
January 27, 2004;
109(3):
335 - 339.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. J Kullo, K. R Bailey, S. L. Kardia, T. H Mosley Jr, E. Boerwinkle, and S. T Turner
Ethnic differences in peripheral arterial disease in the NHLBI Genetic Epidemiology Network of Arteriopathy (GENOA) study
Vascular Medicine,
November 1, 2003;
8(4):
237 - 242.
[Abstract]
[PDF]
|
|
|
|
|
|
|
R. F. Redberg, R. A. Vogel, M. H. Criqui, D. M. Herrington, J. A. C. Lima, and M. J. Roman
Task force #3--what is the spectrum of current and emerging techniques for the noninvasive measurement of atherosclerosis?
J. Am. Coll. Cardiol.,
June 4, 2003;
41(11):
1886 - 1898.
[Full Text]
[PDF]
|
|
|
|
