Race Differences in High-Grade Carotid Artery Stenosis

Abstract

Background and Purpose: Despite a higher incidence of stroke and a more adverse cardiovascular risk factor profile in Blacks and Hispanics compared with Whites, carotid artery revascularization is performed less frequently among these subpopulations. We assessed racial differences in high-grade (≥70% diameter-reducing) carotid stenosis. Methods: Consecutive clients in a Nationwide Life Line for-Profit Service to screen for vascular disease, 2005 to 2019 were evaluated in a cross-sectional study. The prevalence of high-grade stenosis, defined by a carotid ultrasound peak systolic velocity of ≥230 cm/s, was assessed. Participants self-identified as White, Black, Hispanic, Asian, Native American, or other. Race/ethnic differences were assessed using Poisson regression. The number of individuals in the United States with high-grade stenosis was estimated by applying prevalence estimates to 2015 US Census population estimates. Results: The prevalence of high-grade carotid stenosis was estimated in 6 130 481 individuals. The prevalence of high-grade stenosis was higher with increasing age in all race-sex strata. Generally, Blacks and Hispanics had a lower prevalence of high-grade stenosis compared with Whites, while Native Americans had a higher prevalence. For example, for men aged 55 to 65, the relative risk of stenosis compared with Whites was 0.40 (95% CI, 0.29–0.55) and 0.61 (95% CI, 0.46–0.81) for Blacks and Hispanics, respectively; and 1.53 (95% CI, 1.12–2.10) for Native Americans. When these prevalence estimates were applied to the Census estimates of the US population, an estimated 327 721 individuals have high-grade stenosis, of whom 7% are Black, 7% Hispanic, and 43% women. Conclusions: Despite their having a more adverse cardiovascular risk profile, there was a lower prevalence of high-grade carotid artery stenosis for both the Black and Hispanic relative to the White clients. This lower prevalence of high-grade stenosis is a potential contributor to the lower use of carotid revascularization procedures in these minority populations.

A randomized, double-blind, placebo-controlled, multicenter trial- DL-3-n-butylphthalide therapy for cerebral hypoperfusion from unilateral internal carotid system stenosis study: study protocol

“…3 Unfortunately, it had been showed that the carotid stenosis increased consistently with age, and the prevalence of >50% carotid stenoses among ≥80 years of patients was 7.5% and 5.0% for males and females respectively. 2,29,30 In addition, ICAS is more prevalent in the aged and in Asians. [31][32] The current studies and guidelines do not support the percutaneous intracranial stenting and EC-IC employed as first-line treatment in patients with ICAS.…”

Carotid Artery Disease Among Broadly Defined Underrepresented Groups: The All of Us Research Program

“…Consistent with prior reports, when evaluating underrepresented groups defined by race and ethnicity, we found that Black and Hispanic participants had a lower prevalence of CAS. 1,2 Moreover, Black participants had lower estimates of carotid revascularization, which could be explained by lower rates of high-grade stenosis, 1 but other factors should be explored further, including the potential presence of care access bias. Of note, our study may be subject to volunteer bias, leading to an increased number of healthy people enrolled.…”

“…There are marked differences in the prevalence of carotid artery stenosis (CAS) and revascularization among underrepresented groups defined by race and ethnicity. 1,2 It is increasingly recognized that underrepresented groups defined by factors other than race and ethnicity also carry a disproportionate burden of cardiovascular disease. 3 We used the All of Us Research Program 4 to test the hypothesis that the burden of CAS and the proportion of persons who undergo carotid revascularization differ in broadly defined underrepresented groups.…”

Association between carotid intima‐media thickness and cognitive decline differs by race

“…9 Non-Hispanic White individuals might be at a greater risk of developing lipoprotein-rich carotid plaques than Black individuals regardless of lipoprotein levels. [10][11][12] A study conducted on a semi-rural population of Black and White individuals found a cross-sectional association between cIMT and cognitive performance in midlife that was stronger in Black than in White individuals. 13 On the other hand, a cross-sectional analysis of a population-based cohort study, which included African American and non-Hispanic White individuals, verified a stronger association between greater cIMT and lower cognitive function in non-Hispanic White individuals and in participants with higher socioeconomic status, which points to inconsistent findings on the modifying effect of race on the relationship between cIMT and cognitive performance.…”

“…The prevalence of carotid atherosclerosis differs by race/ethnicity 9 . Non‐Hispanic White individuals might be at a greater risk of developing lipoprotein‐rich carotid plaques than Black individuals regardless of lipoprotein levels 10–12 . A study conducted on a semi‐rural population of Black and White individuals found a cross‐sectional association between cIMT and cognitive performance in midlife that was stronger in Black than in White individuals 13 .…”