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Differences in Cardiovascular Risk, Coronary Artery Disease, and Cardiac Events Between Black and White Individuals Enrolled in the PROMISE Trial.

Publication ,  Journal Article
Zhang, L; Olalere, D; Mayrhofer, T; Bittner, DO; Emami, H; Meyersohn, NM; Puchner, SB; Abidov, A; Moloo, J; Dolor, RJ; Mark, DB; Ferencik, M ...
Published in: JAMA Cardiol
March 1, 2022

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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Published In

JAMA Cardiol

DOI

EISSN

2380-6591

Publication Date

March 1, 2022

Volume

7

Issue

3

Start / End Page

259 / 267

Location

United States

Related Subject Headings

  • Risk Factors
  • Plaque, Atherosclerotic
  • Middle Aged
  • Humans
  • Heart Disease Risk Factors
  • Female
  • Coronary Stenosis
  • Coronary Artery Disease
  • Coronary Angiography
  • Chest Pain
 

Citation

APA
Chicago
ICMJE
MLA
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Zhang, L., Olalere, D., Mayrhofer, T., Bittner, D. O., Emami, H., Meyersohn, N. M., … Lu, M. T. (2022). Differences in Cardiovascular Risk, Coronary Artery Disease, and Cardiac Events Between Black and White Individuals Enrolled in the PROMISE Trial. JAMA Cardiol, 7(3), 259–267. https://doi.org/10.1001/jamacardio.2021.5340
Zhang, Lili, Devvora Olalere, Thomas Mayrhofer, Daniel O. Bittner, Hamed Emami, Nina M. Meyersohn, Stefan B. Puchner, et al. “Differences in Cardiovascular Risk, Coronary Artery Disease, and Cardiac Events Between Black and White Individuals Enrolled in the PROMISE Trial.JAMA Cardiol 7, no. 3 (March 1, 2022): 259–67. https://doi.org/10.1001/jamacardio.2021.5340.
Zhang L, Olalere D, Mayrhofer T, Bittner DO, Emami H, Meyersohn NM, et al. Differences in Cardiovascular Risk, Coronary Artery Disease, and Cardiac Events Between Black and White Individuals Enrolled in the PROMISE Trial. JAMA Cardiol. 2022 Mar 1;7(3):259–67.
Zhang, Lili, et al. “Differences in Cardiovascular Risk, Coronary Artery Disease, and Cardiac Events Between Black and White Individuals Enrolled in the PROMISE Trial.JAMA Cardiol, vol. 7, no. 3, Mar. 2022, pp. 259–67. Pubmed, doi:10.1001/jamacardio.2021.5340.
Zhang L, Olalere D, Mayrhofer T, Bittner DO, Emami H, Meyersohn NM, Puchner SB, Abidov A, Moloo J, Dolor RJ, Mark DB, Ferencik M, Hoffmann U, Douglas PS, Lu MT. Differences in Cardiovascular Risk, Coronary Artery Disease, and Cardiac Events Between Black and White Individuals Enrolled in the PROMISE Trial. JAMA Cardiol. 2022 Mar 1;7(3):259–267.

Published In

JAMA Cardiol

DOI

EISSN

2380-6591

Publication Date

March 1, 2022

Volume

7

Issue

3

Start / End Page

259 / 267

Location

United States

Related Subject Headings

  • Risk Factors
  • Plaque, Atherosclerotic
  • Middle Aged
  • Humans
  • Heart Disease Risk Factors
  • Female
  • Coronary Stenosis
  • Coronary Artery Disease
  • Coronary Angiography
  • Chest Pain