TY - JOUR
T1 - Differences in Cardiovascular Risk, Coronary Artery Disease, and Cardiac Events between Black and White Individuals Enrolled in the PROMISE Trial
AU - Zhang, Lili
AU - Olalere, Devvora
AU - Mayrhofer, Thomas
AU - Bittner, Daniel O.
AU - Emami, Hamed
AU - Meyersohn, Nina M.
AU - Puchner, Stefan B.
AU - Abidov, Aiden
AU - Moloo, Jamaluddin
AU - Dolor, Rowena J.
AU - Mark, Daniel B.
AU - Ferencik, Maros
AU - Hoffmann, Udo
AU - Douglas, Pamela S.
AU - Lu, Michael T.
N1 - Funding Information:
reported receiving grants from Astellas Pharma, Boehringer Ingelheim, and Kiniksa outside the submitted work. Dr Moloo reported other from University of Colorado Clinical trial support during the conduct of the study. Dr Mark reported receiving grants from the National Heart, Lung, and Blood Institute and National Institutes of Health during the conduct of the study and grants from HeartFlow, Merck, and Mayo Clinic outside the submitted work. Dr Ferencik reported receiving grants from American Heart Association during the conduct of the study; grants from the National Institutes of Health and consulting fees from Biograph Inc outside the submitted work. Dr Hoffmann reported receiving consulting fees from Duke University and Recor Medical and grants from KOWA, Astra Zeneca, Medimmune, and HeartFlow on behalf of Massachusetts General Hospital outside the submitted work. Dr Douglas reported receiving grants from HeartFlow outside the submitted work. Dr Lu reported receiving grants from AstraZeneca/MedImmune and Kowa, and consulting fees from PQBypass outside the submitted work. No other disclosures were reported.
Funding Information:
Imaging Study for Evaluation of Chest Pain was funded by National Heart, Lung, and Blood Institute grants R01HL098237, R01HL098236, R01HL098305, and R01HL098235.
Publisher Copyright:
© 2022 American Medical Association. All rights reserved.
PY - 2022/3
Y1 - 2022/3
N2 - Importance: Race and ethnicity have been studied as risk factors in cardiovascular disease. How risk factors, epicardial coronary artery disease, and cardiac events differ between Black and White individuals undergoing noninvasive testing for coronary artery disease is not known. Objective: To assess differences in cardiovascular risk burden, coronary plaque, and major adverse cardiac events between Black and White individuals assigned to receive coronary computed tomography angiography (CCTA) or functional testing for stable chest pain. Design, Setting, and Participants: A nested observational cohort study within the PROMISE trial was conducted at 193 outpatient sites in North America. A total of 1071 non-Hispanic Black (hereafter Black) and 7693 non-Hispanic White (hereafter White) participants with stable chest pain undergoing noninvasive cardiovascular testing were included. This analysis was conducted from February 13, 2015, to November 2, 2021. Main Outcomes and Measures: The primary end point was the composite of death, myocardial infarction, or hospitalization for unstable angina over a median follow-up of 24.4 months. Results: Among 1071 Black individuals (12.2%) (women, 646 [60.3%]; mean [SD] age, 59 [8] years) and 7693 White individuals (87.8%) (women, 4029 [52.4%]; mean [SD] age, 61.1 [8.4] years), Black participants had a higher cardiovascular risk burden (more hypertension and diabetes), yet there was a similarly low major adverse cardiovascular events rate over a median 2-year follow-up (32 [3.0%] vs 243 [3.2%]; P =.84). Sensitivity analyses restricted to the 79.8% (6993 of 8764) individuals with a normal or mildly abnormal noninvasive testing result and the 54.3% (4559 of 8396) not receiving statin therapy yielded similar findings. In comparison of Black and White individuals in the CCTA group (n = 3323), significant coronary stenosis (hazard ratio [HR], 7.21; 95% CI, 1.94-26.76 vs HR, 4.30; 95% CI, 2.62-7.04) and high-risk plaque (HR, 3.47; 95% CI, 1.00-12.06 vs HR, 2.21; 95% CI, 1.37-3.57) were associated with major adverse cardiovascular events in both Black and White patients. However, with respect to epicardial coronary artery disease burden, Black individuals had a less-prevalent coronary artery calcium score greater than 0 (45.1% vs 63.2%; P <.001), coronary stenosis greater than or equal to 50% (32 [8.7%] vs 430 [14.6%]; P =.001), and high-risk plaque (139 [37.6%] vs 1547 [52.4%]; P <.001). Conclusions and Relevance: The findings of this study suggest that, despite a greater cardiovascular risk burden in Black persons, rates of coronary artery calcium, stenosis, and high-risk plaque observed via CCTA were lower in Black persons than White persons. This result suggests differences in cardiovascular risk burden and coronary plaque in Black and White individuals with stable chest pain.
AB - Importance: Race and ethnicity have been studied as risk factors in cardiovascular disease. How risk factors, epicardial coronary artery disease, and cardiac events differ between Black and White individuals undergoing noninvasive testing for coronary artery disease is not known. Objective: To assess differences in cardiovascular risk burden, coronary plaque, and major adverse cardiac events between Black and White individuals assigned to receive coronary computed tomography angiography (CCTA) or functional testing for stable chest pain. Design, Setting, and Participants: A nested observational cohort study within the PROMISE trial was conducted at 193 outpatient sites in North America. A total of 1071 non-Hispanic Black (hereafter Black) and 7693 non-Hispanic White (hereafter White) participants with stable chest pain undergoing noninvasive cardiovascular testing were included. This analysis was conducted from February 13, 2015, to November 2, 2021. Main Outcomes and Measures: The primary end point was the composite of death, myocardial infarction, or hospitalization for unstable angina over a median follow-up of 24.4 months. Results: Among 1071 Black individuals (12.2%) (women, 646 [60.3%]; mean [SD] age, 59 [8] years) and 7693 White individuals (87.8%) (women, 4029 [52.4%]; mean [SD] age, 61.1 [8.4] years), Black participants had a higher cardiovascular risk burden (more hypertension and diabetes), yet there was a similarly low major adverse cardiovascular events rate over a median 2-year follow-up (32 [3.0%] vs 243 [3.2%]; P =.84). Sensitivity analyses restricted to the 79.8% (6993 of 8764) individuals with a normal or mildly abnormal noninvasive testing result and the 54.3% (4559 of 8396) not receiving statin therapy yielded similar findings. In comparison of Black and White individuals in the CCTA group (n = 3323), significant coronary stenosis (hazard ratio [HR], 7.21; 95% CI, 1.94-26.76 vs HR, 4.30; 95% CI, 2.62-7.04) and high-risk plaque (HR, 3.47; 95% CI, 1.00-12.06 vs HR, 2.21; 95% CI, 1.37-3.57) were associated with major adverse cardiovascular events in both Black and White patients. However, with respect to epicardial coronary artery disease burden, Black individuals had a less-prevalent coronary artery calcium score greater than 0 (45.1% vs 63.2%; P <.001), coronary stenosis greater than or equal to 50% (32 [8.7%] vs 430 [14.6%]; P =.001), and high-risk plaque (139 [37.6%] vs 1547 [52.4%]; P <.001). Conclusions and Relevance: The findings of this study suggest that, despite a greater cardiovascular risk burden in Black persons, rates of coronary artery calcium, stenosis, and high-risk plaque observed via CCTA were lower in Black persons than White persons. This result suggests differences in cardiovascular risk burden and coronary plaque in Black and White individuals with stable chest pain.
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U2 - 10.1001/jamacardio.2021.5340
DO - 10.1001/jamacardio.2021.5340
M3 - Article
C2 - 34935857
AN - SCOPUS:85122066869
SN - 2380-6583
VL - 7
SP - 259
EP - 267
JO - JAMA Cardiology
JF - JAMA Cardiology
IS - 3
ER -