Key result
African Caribbean ethnicity was associated with a significantly lower prevalence of carotid atherosclerotic plaques compared to European ethnicity (6% vs 16%, RR 0.48), while South Asians had a similar prevalence to Europeans.
Why the study?
ASCVD risk differs by ethnicity, but whether differences in carotid atherosclerosis exist between European, South Asian, and African Caribbean populations or are explained by ASCVD risk factors was unclear.
Does carotid atherosclerosis burden differ among European, South Asian, and African Caribbean ethnicities?
Cross-Sectional (n=991)
Does carotid atherosclerosis burden differ among European, South Asian, and African Caribbean ethnicities?
Carotid plaque prevalence is significantly lower in African Caribbean individuals compared to European and South Asian individuals, independent of traditional ASCVD risk factors, casting doubt on the utility of carotid ultrasound for assessing risk across diverse ethnic groups.
Answers are grounded in this paper and cite their sources.
Ethnic differences in carotid plaque prevalence may limit uniform ultrasound risk stratification; leaves open need for ethnicity-specific prospective validation.
Background: Atherosclerotic cardiovascular disease (ASCVD) risk differs by ethnicity. In comparison with Europeans (EA) South Asian (SA) people in UK experience higher risk of coronary heart disease (CHD) and stroke, while African Caribbean people have a lower risk of CHD but a higher risk of stroke. Aim: To compare carotid atherosclerosis in EA, SA, and AC participants in the Southall and Brent Revisited (SABRE) study and establish if any differences were explained by ASCVD risk factors. Methods: Cardiovascular risk factors were measured, and carotid ultrasound was performed in 985 individuals (438 EA, 325 SA, 228 AC). Carotid artery plaques and intima-media thickness (cIMT) were measured. Associations of carotid atherosclerosis with ethnicity were investigated using generalised linear models (GLMs), with and without adjustment for non-modifiable (age, sex) and modifiable risk factors (education, diabetes, hypertension, total cholesterol, HDL-C, alcohol consumption, current smoking). In those with plaque, total plaque area, numbers of plaques, plaque class, or greyscale median did not differ by ethnicity; adjustment for risk factors had minimal effects. cIMT was higher in AC than the other ethnic groups after adjustment for age and sex, adjustment for risk factors attenuated this difference. Conclusion: Prevalence of carotid artery atherosclerotic plaques varies by ethnicity, independent of risk factors. Lower plaque prevalence in in AC is consistent with their lower risk of CHD but not their higher risk of stroke. Higher cIMT in AC may be explained by risk factors. The similarity of plaque burden in SA and EA despite established differences in ASCVD risk casts some doubt on the utility of carotid ultrasound as a means of assessing risk across these ethnic groups.
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Anbar et al. (2023) conducted a cross-sectional in Carotid atherosclerosis (n=991). African Caribbean ethnicity vs. European ethnicity was evaluated on Prevalence of any carotid plaque (RR 0.48, 95% CI 0.28-0.82, p=0.013). African Caribbean ethnicity was associated with a significantly lower prevalence of carotid atherosclerotic plaques compared to European ethnicity (6% vs 16%, RR 0.48), while South Asians had a similar prevalence to Europeans.
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