Assessing risk for atherosclerotic cardiovascular disease (ASCVD) events is crucial for tailoring preventive strategies. Ethnicity plays a significant role in this risk assessment due to genetic, socioeconomic, lifestyle, and healthcare access differences. Here are just some of the many examples and explanations where ethnicity impacts ASCVD risk:

  1. African Americans:

    • Higher Hypertension Prevalence: African Americans are more likely to develop hypertension at an earlier age and have more severe hypertension, which is a significant risk factor for ASCVD.

    • Elevated Lipoprotein(a) Levels: Studies indicate African Americans often have higher levels of lipoprotein(a), which is associated with an increased risk of cardiovascular events.

    • Risk Assessment Tools: The American College of Cardiology (ACC) ASCVD Risk Calculator includes adjustments for African Americans, recognizing their elevated risk compared to other ethnic groups.

  2. South Asians:

    • Higher Incidence of Diabetes: South Asians have a higher predisposition to diabetes and insulin resistance, leading to an increased risk of ASCVD.

    • Central Obesity: South Asians tend to accumulate fat around the abdomen, a key risk factor for cardiovascular diseases.

    • Risk Thresholds: The European Society of Cardiology (ESC) guidelines highlight that South Asians have a higher risk of myocardial infarction and should be monitored closely for cardiovascular risk factors even at lower body mass index (BMI) thresholds.

  3. Hispanics/Latinos:

    • Diverse Risk Profiles: This group has diverse backgrounds with varying ASCVD risk profiles. For instance, Mexican Americans have higher rates of diabetes and obesity, while Puerto Ricans have a higher prevalence of hypertension.

    • Risk Underestimation: Traditional risk calculators may underestimate the risk in Hispanic/Latino populations due to differences in baseline risk factors and socioeconomic determinants of health.

  4. East Asians:

    • Lower LDL-C Levels: East Asians generally have lower levels of low-density lipoprotein cholesterol (LDL-C), but they may still have significant coronary artery disease due to other factors such as higher rates of smoking and hypertension.

    • Stroke Risk: There is a higher propensity for stroke rather than coronary artery disease in East Asians, indicating the need for tailored prevention strategies.

Table showing hypertension prevalence by ethnicity, with African American at 57%, White at 43%, Hispanic/Latino at 42%, and Asian at 41%.
Table showing diabetes prevalence percentages by ethnicity, including South Asian, African American, Hispanic/Latino, White, and Asian.
Table showing average LDL-C levels by ethnicity with values: White 114, African American 113, Hispanic/Latino 106, Asian 100.

Risk Thresholds

ASCVD Risk Calculator Adjustment Factors

The basic ASCVD risk calcuator tools consider varying amounts of ethnic data when identifying individual risk for suffering a heart attack or stroke. Some examples:

  • African American: 1.5 times the risk for similar age and gender white individuals.

  • South Asian: Risk is comparable to Caucasians but with an earlier onset of events.

  • Hispanic/Latino: Adjusted based on subgroup analysis due to varied risk profiles.

  • East Asian: Lower LDL-C thresholds for initiating statin therapy due to higher stroke risk.

However, none of the individual guidelines fully harmonizes all of the ethnic variations along with 40+ other Risk Enhacing Factors that we use to inform the individual results reflected in the Cardiometabolic Risk Assessment.

References

  1. American College of Cardiology (ACC):

    • ASCVD Risk Estimator Plus. Available at: ACC Risk Estimator

  2. National Lipid Association (NLA):

    • Recommendations on Lipoprotein(a). Journal of Clinical Lipidology. Available at: NLA Guidelines

  3. European Society of Cardiology (ESC):

    • ESC Guidelines on Cardiovascular Disease Prevention in Clinical Practice. Available at: ESC Guidelines

Understanding these ethnic differences allows for more precise risk stratification and tailored preventive measures, ultimately improving cardiovascular outcomes across diverse populations.

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