Racism and Cardiology: A Global Call to Action

Banerjee, S.; Cader, Fathima Aaysha; Gulati, Martha; Capers, Quinn

doi:10.1016/j.cjco.2021.09.014

Cited by 24 publications

(20 citation statements)

References 82 publications

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“…Nonetheless, the bias in care requires efforts directed toward the medical community. Education and bias mitigation training are required to overcome the persistent differences in the treatment of ACS in women compared with men [ 158 , 159 ]. In regions where technology permits, additional improvements in ACS outcomes of women can be recognized by the use of protocol-driven care of STEMI to further reduce bias based on sex or race, using prompts through electronic health records and ensuring adherence to timely and guideline-directed medical therapies [ 76 , 85 ].…”

Section: Targeted Action Plansmentioning

confidence: 99%

Sex Differences in Acute Coronary Syndromes: A Global Perspective

Cader

Banerjee

Gulati

2022

JCDD

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Despite increasing evidence and improvements in the care of acute coronary syndromes (ACS), sex disparities in presentation, comorbidities, access to care and invasive therapies remain, even in the most developed countries. Much of the currently available data are derived from more developed regions of the world, particularly Europe and the Americas. In contrast, in more resource-constrained settings, especially in Sub-Saharan Africa and some parts of Asia, more data are needed to identify the prevalence of sex disparities in ACS, as well as factors responsible for these disparities, particularly cultural, socioeconomic, educational and psychosocial. This review summarizes the available evidence of sex differences in ACS, including risk factors, pathophysiology and biases in care from a global perspective, with a focus on each of the six different World Health Organization (WHO) regions of the world. Regional trends and disparities, gaps in evidence and solutions to mitigate these disparities are also discussed.

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Section: Targeted Action Plansmentioning

confidence: 99%

Sex Differences in Acute Coronary Syndromes: A Global Perspective

Cader

Banerjee

Gulati

2022

JCDD

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“…Our failure to identify factors explaining ethnic differences in carotid atherosclerotic plaque despite adjustment for ASCVD risk factors suggests that important determinants of ethnic differences in atherosclerosis susceptibility remain to be identified. Mechanisms related to population migration ( 27 ), socio-economic disadvantage ( 28 ) and racism ( 28 , 29 ) seem plausible explanations, but given the differences observed between minority ethnic groups in this study this question merits further study. We cannot exclude genetic differences between populations of difference ancestry but currently there is little or no evidence to suggest that genetics makes a major contribution to ethnic differences in susceptibility to ASCVD ( 30 , 31 ).…”

Section: Discussionmentioning

confidence: 84%

Carotid atherosclerosis in people of European, South Asian and African Caribbean ethnicity in the Southall and Brent revisited study (SABRE)

Anbar

Chaturvedi

Eastwood

et al. 2023

Front. Cardiovasc. Med.

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BackgroundAtherosclerotic 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.AimTo 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.MethodsCardiovascular 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).ResultsPrevalence of any plaque was similar in EA and SA, but lower in AC (16, 16, and 6%, respectively; p < 0.001). 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.ConclusionPrevalence 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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“…Our failure to identify factors explaining ethnic differences in carotid atherosclerotic plaque despite extensive adjustment for conventional and novel risk factors suggests that important determinants of atherosclerosis remain to be identified. Mechanisms related to population migration,(31) socio-economic disadvantage(32) and racism (32,33) seem plausible explanations, but given the differences observed between minority ethnic groups in this study this question merits further study. We cannot exclude genetic differences between populations of difference ancestry but currently there is little or no evidence to suggest that genetics makes an important contribution to ethnic differences in susceptibility to CVD.…”

Section: Discussionmentioning

confidence: 86%

Carotid atherosclerosis in people of European, South Asian and African Caribbean ethnicity in the Southall and Brent Revisited study (SABRE)

Anbar

Chaturvedi

Eastwood

et al. 2022

Preprint

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Background Atherosclerotic cardiovascular disease (CVD) risk differs by ethnicity. In comparison with Europeans (EA) South Asian (SA) people in UK experience higher risk of coronary heart disease and stroke, while African Caribbean people have a lower risk of coronary heart disease 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 established or novel CVD risk factors. Methods Cardiovascular risk factors were measured, and carotid ultrasound was performed in 985 individuals (438 EA, 325 SA, 228 AC). Carotid plaques, and intima-media thickness (cIMT) were measured. Associations of carotid atherosclerosis with ethnicity were investigated using regression analyses, with and without adjustment for potential confounders (age, sex) and mediators (education, diabetes, hypertension, total cholesterol, HDL-C, alcohol consumption, current smoking). Results: Prevalence of any plaque was similar in EA and SA, and lower in AC (17%, 17%, and 6% respectively; p < 0.001 by ANOVA). Total plaque area was also similar in EA and SA but reduced in AC, but there were no major differences in the maximum height or length of plaques in people with plaques by ethnic group. These ethnic differences were unaffected by adjustment for potential confounders or mediators. After adjustment for age and sex cIMT was higher in AC but this difference was attenuated by adjustment for CVD risk factors. Conclusions: Prevalence of carotid artery atherosclerotic plaques varies by ethnicity, independent of risk factors. The similarity of plaque burden in SA and EA despite established differences in CVD risk in these ethnic groups casts some doubt on the utility of carotid ultrasound as a means of assessing risk across ethnic groups.

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Racism and Cardiology: A Global Call to Action

Cited by 24 publications

References 82 publications

Sex Differences in Acute Coronary Syndromes: A Global Perspective

Sex Differences in Acute Coronary Syndromes: A Global Perspective

Carotid atherosclerosis in people of European, South Asian and African Caribbean ethnicity in the Southall and Brent revisited study (SABRE)

Carotid atherosclerosis in people of European, South Asian and African Caribbean ethnicity in the Southall and Brent Revisited study (SABRE)

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