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Type: Journal article
Title: Progression of coronary atherosclerosis in African-American patients
Author: Kataoka, Y.
Hsu, A.
Wolski, K.
Uno, K.
Puri, R.
Tuzcu, E.
Nissen, S.
Nicholls, S.
Citation: Cardiovascular Diagnosis and Therapy, 2013; 3(3):161-169
Publisher: AME Publishing
Issue Date: 2013
ISSN: 2223-3652
2223-3660
Statement of
Responsibility: 
Yu Kataoka, Amy Hsu, Kathy Wolski, Kiyoko Uno, Rishi Puri, E. Murat Tuzcu, Steven E. Nissen, Stephen J. Nicholls
Abstract: BACKGROUND: African-Americans with coronary artery disease (CAD) demonstrate worse clinical outcomes than Caucasians. While this is partly due to a lack of accessibility to established therapies, the mechanisms underlying this difference remain to be elucidated. We aimed to characterize the progression of coronary atherosclerosis in African-Americans with CAD. METHODS: 3,479 patients with CAD underwent serial intravascular ultrasound (IVUS) imaging to evaluate atheroma progression in 7 clinical trials of anti-atherosclerotic therapies. Risk factor control and atheroma progression were compared between African-Americans (n=170) and Caucasians (n=3,309). RESULTS: African-Americans were more likely to be female (51.8% vs. 28.1%, P<0.001), have a higher body mass index (32.8±6.0 vs. 31.3±5.8 kg/m(2), P=0.002) and greater history of hypertension (85.9% vs. 78.8%, P=0.02), diabetes (41.8% vs. 30.6%, P=0.002) and stroke (12.9% vs. 3.0%, P<0.001). Despite a high use of anti-atherosclerotic medications (93% statin, 89% aspirin, 79% β-blocker, 52% ACE inhibitor), African-Americans demonstrated higher levels of LDL-C (2.4±0.7 vs. 2.2±0.7 mmol/L, P=0.006), CRP (2.9 vs. 2.0 mg/dL, P<0.001) and systolic blood pressure (133±15 vs. 129±13 mmHg, P<0.001) at follow-up. There was no significant difference in atheroma volume at baseline (189.0±82.2 vs. 191.6±83.3 mm(3), P=0.82) between two groups. Serial evaluation demonstrated a greater increase in atheroma volume in African-Americans (0.51±2.1 vs. -3.1±1.7 mm(3), P=0.01). This difference persisted with propensity matching accounting for differences in risk factor control (0.1±2.1 vs. -3.7±1.7 mm(3), P=0.02). CONCLUSIONS: African-Americans with CAD achieve less optimal risk factor control and greater atheroma progression. These findings support the need for more intensive risk factor modification in African-Americans.
Keywords: African-American; coronary atherosclerosis; intravascular ultrasound (IVUS)
Rights: Copyright status unknown
RMID: 0030021270
DOI: 10.3978/j.issn.2223-3652.2013.08.05
Appears in Collections:Medicine publications

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