Key result
Black ethnicity is linked to ~52% lower CAD prevalence in stroke patients versus White patients.
Why the study?
In the USA, coronary artery disease is paradoxically less prevalent in ethnic minorities despite higher vascular risk factors, which is often considered an artifact of healthcare access disparities. The authors sought to determine if this paradox persists in the UK with equitable healthcare access.
Does the prevalence of coronary artery disease differ between ethnic minorities (Blacks, Asians) and Whites in the UK despite differences in vascular risk factors?
Cohort (n=7,297)
Yes
Does the prevalence of coronary artery disease differ between ethnic minorities (Blacks, Asians) and Whites in the UK despite differences in vascular risk factors?
A 'coronary artery disease paradox' exists in the UK, where Black patients have lower rates of CAD compared to Whites despite a higher prevalence of vascular risk factors, suggesting biological differences rather than just healthcare access disparities.
Answers are grounded in this paper and cite their sources.
Warrants caution extrapolating CAD data across ethnicities in stroke; leaves open distinct mechanisms and prevention strategies.
Background and aims In the USA, coronary artery disease (CAD) is paradoxically less prevalent in ethnic minorities versus Whites despite higher prevalence of vascular risk factors. As this is often considered an artifact due to US-specific healthcare access disparities, we aimed to determine if such a paradox persists in the UK population with equitable access to care. Methods We collected data on vascular risk factors and history of CAD in all patients with TIA/stroke in a UK population-based study (2002-2023). We used multivariable logistic regression to compare rates of prevalent CAD in Asians and Blacks versus Whites, adjusting for age, sex, vascular risk factors, and socioeconomic deprivation. We verified our findings in a meta-analysis of published studies across the UK. Results Among 7297 TIA/stroke patients (47.4% women, 71.0 ± 15.5 years, 335 non-Whites), 117 Blacks had more diabetes than Whites (adjusted-OR = 3.16, 95%CI = 2.03-4.92, P < 0.001), but less CAD (0.50,0.18-1.41,P = 0.06). Asians also had more diabetes than Whites (3.93,2.77-5.57,P < 0.001) but no excess CAD (1.18,0.67-2.10,P = 0.57). Among other UK-based studies of stroke patients, Blacks also had less CAD than Whites (pooled OR = 0.48, 0.31-0.76; P = 0.002,n = 3) and Asians (0.30, 0.10-0.80, P = 0.015,n = 2) despite higher prevalence of hypertension (1.95,1.47-2.60, P < 0.001,n = 3; 1.47,1.02-2.12, P < 0.001,n = 6) and diabetes (2.78,2.40-3.22,P < 0.001,n = 3; 4.15,3.11-5.53, P < 0.001,n = 6). In stroke-free UK populations (n = 3), CAD rates were lower in Blacks versus Whites (0.25,0.13-0.46, P < 0.001) or Asians (0.40,0.30-0.50,P < 0.001). Conclusions A coronary artery disease paradox exists in Blacks living in the UK, which is unlikely to solely reflect biases in healthcare access and suggests different biological susceptibilities. Conflict of interest Funding: Joseph Kamtchum-Tatuene is funded by a Wellcome Early Career Award (304532/Z/23/Z). Linxin Li is funded by the Oxford Science of Mind Fellowship and the NIHR Advanced Fellowship (NIHR303662) Peter M. Rothwell is funded by the National Institute for Health and Care Research (NIHR), the Oxford Biomedical Research Center (IS-BRC-1215-20008), the Wolfson Foundation, and the Wellcome Trust (104040/Z/14/Z). The funders had no role in study design; in collection, analysis, and interpretation of data; in report writing; or in the decision to submit the paper for publication. Disclosures: The authors have no conflict of interest to disclose. The views expressed are those of the authors and not necessarily those of their employers or funders.
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Kamtchum-Tatuene et al. (2026) conducted a cohort in TIA/stroke (n=7,297). Black ethnicity vs. White ethnicity was evaluated on Prevalent coronary artery disease (OR 0.50, 95% CI 0.18-1.41, p=0.06). Black ethnicity in UK stroke patients was associated with lower coronary artery disease prevalence compared to White ethnicity (pooled OR 0.48; 95% CI 0.31-0.76; P=0.002) despite more risk factors.
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