doi: 10.1161/01.CIR.0000157730.94423.4B
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(Circulation. 2005;111:1313-1320.)
© 2005 American Heart Association, Inc.
Vascular Medicine |
Ethnic Differences in Coronary Calcification
The Multi-Ethnic Study of Atherosclerosis (MESA)
From the Division of Epidemiology and Clinical Applications (D.E.B.), National Heart, Lung, and Blood Institute, Bethesda, Md; Harbor-UCLA Research and Education Institute (R.D.), Torrance, Calif; Department of Biostatistics (D.P.), University of Washington, Seattle; St. Francis Hospital (A.G.), Roslyn, NY; Department of Preventive Medicine (K.L.), Northwestern University, Chicago, Ill; Division of Epidemiology (E.S.), School of Public Health, University of Minnesota, Minneapolis; Division of Cardiology (P.O.), Johns Hopkins University School of Medicine, Baltimore, Md; Department of Public Health Sciences (S.J.), Wake Forest University, Winston-Salem, NC; and Department of Medicine (M.F.S.), UCLA School of Medicine, Los Angeles, Calif.
Reprint requests to Collaborative Health Studies Coordinating Center, Box 354922, University of Washington, Bldg 29, Suite 310, 6200 NE 74th St, Seattle, WA 98115-8160. Correspondence to Diane Bild, MD, MPH, National Heart, Lung, and Blood Institute, 6701 Rockledge Dr, MSC 7438, Bethesda, MD 20892-7438. E-mail bildd{at}nhlbi.nih.gov
Received September 30, 2004; revision received January 11, 2005; accepted January 13, 2005.
Background— There is substantial evidence that coronary calcification, a marker for the presence and quantity of coronary atherosclerosis, is higher in US whites than blacks; however, there have been no large population-based studies comparing coronary calcification among US ethnic groups.
Methods and Results— Using computed tomography, we measured coronary calcification in 6814 white, black, Hispanic, and Chinese men and women aged 45 to 84 years with no clinical cardiovascular disease who participated in the Multi-Ethnic Study of Atherosclerosis (MESA). The prevalence of coronary calcification (Agatston score >0) in these 4 ethnic groups was 70.4%, 52.1%, 56.5%, and 59.2%, respectively, in men (P<0.001) and 44.6%, 36.5%, 34.9%, and 41.9%, respectively, (P<0.001) in women. After adjustment for age, education, lipids, body mass index, smoking, diabetes, hypertension, treatment for hypercholesterolemia, gender, and scanning center, compared with whites, the relative risks for having coronary calcification were 0.78 (95% CI 0.74 to 0.82) in blacks, 0.85 (95% CI 0.79 to 0.91) in Hispanics, and 0.92 (95% CI 0.85 to 0.99) in Chinese. After similar adjustments, the amount of coronary calcification among those with an Agatston score >0 was greatest among whites, followed by Chinese (77% that of whites; 95% CI 62% to 96%), Hispanics (74%; 95% CI 61% to 90%), and blacks (69%; 95% CI 59% to 80%).
Conclusions— We observed ethnic differences in the presence and quantity of coronary calcification that were not explained by coronary risk factors. Identification of the mechanism underlying these differences would further our understanding of the pathophysiology of coronary calcification and its clinical significance. Data on the predictive value of coronary calcium in different ethnic groups are needed.
Key Words: epidemiology • atherosclerosis • coronary disease • calcium
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