Review Articles

Racial Disparities in the Cardiac Computed Tomography Assessment of Coronary Artery Disease

Does Gender Matter

El-Menyar, Ayman MD^*,†; Abuzaid, Ahmed MD^‡; Elbadawi, Ayman MD^§; McIntyre, Matthew BA^¶; Latifi, Rifat MD^‖

From the ^*Clinical Medicine, Weill Cornell Medical College, Doha, Qatar

^†Division of Cardiology, Department of Medicine, Westchester Medical Center, Valhalla, NY

^‡Cardiology Department, Sidney Kimmel Medical College at Thomas Jefferson University/Christiana Care Health System, Newark, DE

^§Department of Internal Medicine, Rochester General Hospital, Rochester, NY

^¶New York Medical College, Valhalla, NY

^‖Department of Surgery, Westchester Medical Center, Valhalla, NY.

Disclosure: The authors declare no conflict of interest.

Correspondence: Ayman El-Menyar, MD, Weill Cornell Medical School, Doha, Qatar. E-mail: [email protected].

Cardiology in Review 27(1):p 14-22, January/February 2019. | DOI: 10.1097/CRD.0000000000000206

Abstract

Coronary heart disease (CHD) represents a significant healthcare burden in terms of hospital resources, morbidity, and mortality. Primary prevention and early detection of risk factors for the development of CHD are pivotal to successful intervention programs and prognostication. Yet, there remains a paucity of evidence regarding differences in the assessment of these risk factors and the tools of assessment among different ethnicities. We conducted a narrative review to assess the utility of cardiac computed tomography, particularly coronary artery calcification (CAC), in different ethnicities. We also looked to see whether age, sex, comorbidities, and genetic background have peculiar influences on CAC. In this review, we highlight some of the pivotal studies regarding the question of CAC in relation to the development of CHD among different ethnicities. We identify several key trends in the literature showing that although African Americans have high rates of CHD, their risk of CAC may be relatively lower compared with other ethnicities. Similarly, South Asian patients may be at a high risk for adverse cardiac events due to elevated CAC. We also note that several studies are limited by small sample size and were based on 1 large cohort study. Future studies should include a large international prospective cohort to truly evaluate the effects of ethnicity on CAC and CHD risk. To appropriately apply CAC in the clinical practice, the variations in its scoring based on a subject’s age, sex, comorbidity, and ethnicity should be addressed and interpreted beforehand.