Identifying Differences: A Key Step in Precision Cardiovascular Disease Prevention

nderstanding differences in pathobiology and response to treatment based on an individual's sex, race, and ethnicity are becoming ever more crucial as we strive to move away from the "one size fits all" management approach to one that is more precise and individualized.Several sex-specific contributors to cardiovascular risk have already been identified.The most recent cholesterol guidelines identified preeclampsia and premature menopause as risk-enhancing factors among women. 1 Similarly, South Asian (SA) ethnicity is now recognized as a risk enhancing factor.Along with identifying risk enhancers and risk factors, identifying pre-or subclinical atherosclerosis is an important tool to further refine and improve cardiovascular disease (CVD) risk stratification and enable shared decision making regarding preventive therapy. 1 In this context, Nonterah et al present in this issue of the Journal of the American Heart Association (JAHA) their analyses using pooled data from multiple cohorts from multiple countries (n=34 025) representing various race and ethnic groups.They examined carotid intima-media thickness (cIMT) and explored the association of cardiovascular risk factors with cIMT. 2 Adjusted cIMT was highest among African Americans followed by Asian, European, Hispanic, and African populations.In analyses restricted to African populations, cIMT was highest among African Americans, followed by West Africans, South Africans, and East Africans.In each group, cIMT was higher among men compared with women.The authors evaluated the association between cardiovascular risk factors and cIMT in each race and ethnic group and identified some unique patterns.Compared with European populations, the magnitude of association of age, sex, and systolic blood pressure with cIMT was weaker in all races and ethnicities.Physical activity was inversely related to cIMT among European and African populations but directly related to cIMT among Asian populations.High-density lipoprotein cholesterol had the strongest inverse association with cIMT among African American and African populations followed by European populations, while it was not significant among Asian populations.Smoking, body mass index , and glucose had the strongest association with cIMT among Asian individuals.The authors should be congratulated on this important work combining various cohorts with multiple race and ethnic groups from different countries.Importantly, they performed analyses in subgroups of African ethnicity in various regions of Africa and the United States.They conducted a 2-stage individual participant level data meta-analysis, which allowed them to perform