April 20, 2026Journal of the American College of Cardiology
Multi-Ethnic Study of Atherosclerosis (MESA)
Key result
Noninvasive subclinical atherosclerosis evaluation in MESA predicts CVD risk beyond traditional risk factors.
Population
Sex-balanced, multiethnic, community-dwelling U.S. cohort
Design
Review
Authors
Discussion
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Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
SKSadiya KhanCardiovascular epidemiologist, Northwestern University Feinberg School of Medicine
“I think this study reinforces two important points. First, there is the importance of a diverse population sample in which to develop models. Second is ensuring that the relevant predictors are included. With these two things in place, the model performs well, even without the social construct of race.”
QWQuinn WhiteDoctoral student in biostatistics, University of Washington
“Our work is part of a growing effort to assess the implications of including race and ethnicity in clinical risk prediction models. This change broadens the potential use of the score, since it can now be calculated for those who do not fit into one of the racial or ethnic groups of the original score and for those who do not wish to disclose their race.”
QWQuinn WhiteDoctoral student in biostatistics, University of Washington
“When we don't include race/ethnicity in the model development process, we see that the model performs comparably to the model that does include race/ethnicity. These models were similar both in their ability to distinguish events from nonevents, and in the extent to which the models' predicted event rates were very close to the observed event rates. We also assessed model performance stratified by race/ethnicity, and we saw that the models performed similarly within each group. That is, including race/ethnicity is not changing the predictions of the MESA score in a meaningful way.”
Implication
May refine risk stratification with CAC imaging in diverse cohorts; leaves open randomized trials linking it to treatment changes.
Key Points
- This research aims to explore cardiovascular disease prevalence and progression in a diverse community cohort.
- Prospective study design sponsored by the National Heart, Lung, and Blood Institute.
- Focus on community-dwelling, multiethnic participants with a balanced sex ratio.
- Evaluation includes noninvasive methods for assessing atherosclerosis and determining cardiovascular risk.
- Identified new noninvasive assessment tools for subclinical atherosclerosis.
- Informed international guidelines in cardiovascular patient care.
- Contributed significantly to understanding determinants of cardiovascular disease risk.
Structured PICO
P
Population
Sex-balanced, multiethnic, community-dwelling U.S. cohort
MESA has significantly advanced the understanding of subclinical atherosclerosis and informed international patient care guidelines for cardiovascular risk assessment.
Cite This Study
Blaha et al. (2021) conducted a review in Subclinical cardiovascular disease. The Multi-Ethnic Study of Atherosclerosis (MESA) has advanced the noninvasive evaluation of subclinical atherosclerosis to predict cardiovascular disease risk beyond traditional risk factors.