Risk stratification for coronary artery disease in multi-ethnic populations: Are there broader considerations for cost efficiency?

Abstract

Coronary artery disease (CAD) screening and diagnosis are core cardiac specialty services. From symptoms, autopsy correlations supported reductions in coronary blood flow and dynamic epicardial and microcirculatory coronaries artery disease as etiologies. While angina remains a clinical diagnosis, most cases require correlation with a diagnostic modality. At the onset of the evidence building process much research, now factored into guidelines were conducted among population and demographics that were homogenous and often prior to newer technologies being available. Today we see a more diverse multi-ethnic population whose characteristics and risks may not consistently match the populations from which guideline evidence is derived. While it would seem very unlikely that for the majority, scientific arguments against guidelines would differ, however from a translational perspective, there will be populations who differ and importantly there are cost-efficacy questions, e.g ., the most suitable first-line tests or what parameters equate to an adequate test. This article reviews non-invasive diagnosis of CAD within the context of multi-ethnic patient populations.

Vitamin D supplementation effects on the clinical outcomes of patients with coronary artery disease: a systematic review and meta-analysis

“…Among the risk factors associated with CAD, obesity, diabetes, hypertension, and physical inactivity are the most common forms. Also, according to previous studies, vitamin D deficiency could act as a risk factor for CAD 6 – 8 . The proposed mechanisms for these effects include increased levels of renin and angiotensin II, calcification and smooth muscle proliferation, followed by increased lipid profile and features of metabolic syndrome 4 , 9 , 10 .…”

The impact of serum 25-hydroxyvitamin D, calcium, and parathyroid hormone levels on the risk of coronary artery disease in patients with diabetes: a Mendelian randomization study

“…It was shown that lower serum bioavailable and free 25OHD levels were associated with prevalent cardiovascular mortality independent of other recognized cardiovascular risk factors [ 38 ]. Vitamin D deficiency might be considered a so-called “nonclassical” CAD risk factor in studies without a specific focus on diabetes [ 39 , 40 ]. However, the two recent large scale RCTs failed to demonstrate a beneficial effect of 25OHD on CAD [ 41 , 42 ].…”

The Impact of Serum 25-hydroxyvitamin D, Calcium, and Parathyroid Hormone Levels on the Risk of Coronary Artery Disease in Patients With Diabetes: A Mendelian Randomization Study

“…[35] Vitamin D de ciency might be considered a so-called "nonclassical" CAD risk factor in studies without a speci c focus on diabetes. [36,37] However, the two recent large scale RCTs failed to demonstrate a bene cial effect of 25OHD on CAD. [38,39] Consistently, PTH is a key regulator of Ca homeostasis.…”