Racial and Ethnic Differences in Long-Term Cardiovascular Mortality Among Women and Men From the CAC Consortium

Background: Despite an increasingly diverse population, knowledge regarding racial and ethnic disparities is limited among women and men undergoing atherosclerotic cardiovascular (ASCVD) risk assessment. Objectives: The aim of this study was to compare cardiovascular (CV) mortality by ASCVD risk and coronary artery calcium (CAC) scores among Black and Hispanic women and men compared with other participants. Methods: From the CAC Consortium, 42,964 participants with self-reported race and ethnicity were followed for a median of 11.7 years. Multivariable Cox proportional hazards regression models were used to estimate CV mortality, with separate analyses by sex. Results: One-third of enrollees were women; 977 self-reported as Black, 1,349 as Hispanic, 1,621 as Asian, and 740 as American Indian/Native Alaskan/Hawaiian or unspecified; the remainder were White. Black women and men had higher ASCVD risk and CAC scores yielding the highest CV mortality compared with other participants. Among Black women and men with a 0 CAC or ASCVD risk score <5%, HRs were 6- to 9-fold higher than that of other women and men. In men with CAC scores ≥100, Black men (HR: 4.2; P < 0.001) had the highest CV mortality compared to all other men. A similar high-risk pattern was noted for Black women with CAC scores ≥100 (P < 0.001), even with adjustment for the ASCVD risk score. Overall, Hispanics had an intermediate CV mortality, less than that of Black participants. This was notable for Hispanic men with a CAC score of 0 (HR: 3.6; P = 0.006) and CAC ≥100 (HR: 2.3; P = 0.03). Conclusions: The disproportionately high and excess CV mortality among Black women and men represents significant barriers to reducing the burden of ASCVD through effective risk assessment using ASCVD risk and CAC scores.