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:
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.
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.
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.
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.
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
American College of Cardiology (ACC):
ASCVD Risk Estimator Plus. Available at: ACC Risk Estimator
National Lipid Association (NLA):
Recommendations on Lipoprotein(a). Journal of Clinical Lipidology. Available at: NLA Guidelines
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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