Key result
Black women show ~48% lower odds of carotid plaque than white women despite worse risk factors.
Why the study?
The extent to which CVD risk factors across the menopause explain racial/ethnic differences in subclinical vascular disease in late midlife women is not well documented.
Do traditional CVD risk factor associations with late midlife subclinical vascular disease vary by race/ethnicity?
Cohort (n=1,357)
Yes
Do traditional CVD risk factor associations with late midlife subclinical vascular disease vary by race/ethnicity?
Odds Ratio: 0.52 (95% CI 0.38–0.71)
Absolute Event Rate: 39.9% vs 47.2%
p-value: p=<0.001
Traditional CVD risk factors measured across the menopause transition are associated with subclinical vascular disease similarly across racial and ethnic groups, though unmeasured factors likely drive residual racial/ethnic differences in vascular outcomes.
Lower plaque prevalence in Black women despite adverse risk factors cautions against uniform risk stratification; leaves open contributions of unmeasured factors to racial disparities.
Background The extent to which cardiovascular disease (CVD) risk factors across the menopause explain racial/ethnic differences in subclinical vascular disease in late midlife women is not well documented and was explored in a multi-ethnic cohort. Methods and Results Participants (n=1357; mean age 60 years) free of clinical CVD from the Study of Women's Health Across the Nation had common carotid artery intima-media thickness, interadventitial diameter, and carotid plaque presence assessed by ultrasonography on average 13.7 years after baseline visit. Early to late midlife time-averaged cumulative burden of traditional CVD risk factors calculated using serial measures from baseline to the ultrasound visit were generally less favorable in black and Hispanic women compared with white and Chinese women, including education and smoking status and time-averaged cumulative blood pressure, high-density lipoprotein cholesterol, and fasting insulin. Independent of these risk factors, BMI, and medications, common carotid artery intima-media thickness was thicker in black women, interadventitial diameter was wider in Chinese women, yet plaque presence was lower in black and Hispanic women compared with white women. CVD risk factor associations with subclinical vascular measures did not vary by race/ethnicity except for high-density lipoprotein cholesterol on common carotid artery intima-media thickness; an inverse association between high-density lipoprotein cholesterol and common carotid artery intima-media thickness was observed in Chinese and Hispanic but not in white or black women. Conclusions Race/ethnicity did not particularly moderate the association between traditional CVD risk factors measured across the menopause transition and late midlife subclinical vascular disease. Unmeasured socioeconomic, cultural, and nontraditional biological risk factors likely play a role in racial/ethnic differences in vascular health and merit further exploration.
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Barinas‐Mitchell et al. (2020) conducted a cohort in Subclinical vascular disease (n=1,357). Black race/ethnicity vs. White race/ethnicity was evaluated on Carotid plaque presence (OR 0.52, 95% CI 0.38-0.71, p=<0.001). Black women had a significantly lower prevalence of carotid plaque compared with white women (OR 0.52), despite having a generally less favorable traditional cardiovascular risk factor profile.
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