Subclinical coronary atherosclerosis: Racial profiling is necessary!

Objectives: We aim to review the studies comparing coronary calcification across different ethnic groups. Background: There is still uncertainty regarding ethnic differences in the prevalence, progression, and risk of coronary artery disease. Clues to possible racial differences in rates of coronary heart disease (CHD) may be found by identifying subclinical disease. Coronary artery calcification (CAC) can be used to predict risk of CHD in both symptomatic and asymptomatic subjects. Methods: Online databases were searched for studies assessing racial differences in CAC. Results: Most of the published studies have shown that racial differences exist in the prevalence and severity of CAC. Whites have a higher prevalence of CAC as compared to African Americans and other ethnic groups even after adjustment for risk factors. These differences in CAC are even more pronounced in men and in the elderly. Data regarding the distribution of CAC in ethnic groups outside the United States are limited. Emerging evidence indicates that while several ethnic groups outside the United States tend to have a greater prevalence of CHD risk factors, their prevalence of CAC is lower, as compared with Americans. Thus, the data obtained in the United States may not be able to be fully extrapolated to populations outside the United States for assessment of CHD risk. Conclusions: The presence and extent of CAC varies among different racial groups within and outside the United States. The relationship between calcification and the incidence of CHD in these ethnic groups needs further exploration. Thus, it is important to develop ethnic specific CAC nomograms to more accurately determine the underlying CHD risk associated with CAC in these individuals. It will also be imperative to obtain outcome data and relate it to baseline levels of CAC to help us put in perspective the significance of racial differences in CAC and how they impact on cardiac risk prediction.