Racial Disparities in Early Subclinical Atherosclerosis: Insights from the FAMILIA Study

Abstract

Introduction: African-Americans are at a greater risk of cardiovascular (CV) events. Differential race vulnerability to early subclinical atherosclerosis disease is likely, and yet few studies have addressed this relationship.

Objective: To study the impact of race on the presence of early subclinical atherosclerosis in adults enrolled in the “Family-Based Approach in a Minority Community Integrating Systems-Biology for Promotion of Health” (FAMILIA) study.

Methods: A total of 431 adults, including parents/caregivers and staff, recruited in the FAMILIA study from 15 Head Start preschools in Harlem (New York) and with no previous history of CV disease, underwent bilateral carotid and femoral three-dimensional vascular ultrasound. The 10-year Framingham CV risk was calculated, and the relationship between race and the presence of subclinical atherosclerosis was analysed by using multivariate logistic regression models and receiver operating characteristic (ROC) curves.

Results: Mean age of participants was 38.1±11.1 years, 83% female, 66% Hispanic/Latino, 34% non-Hispanic Black. Mean 10-year Framingham CV risk was 3.8% with no significant differences by race. The overall prevalence of subclinical atherosclerosis was 8.6%, and was significantly higher in non-Hispanic Blacks (12.2%) than in Hispanic/Latino participants (6.7%) [Figure 1A]. Adjusted by 10-year Framingham CV risk, non-Hispanic Blacks were more likely to have subclinical atherosclerosis than Hispanic/Latino (odds ratio = 2.18; 95% CI, 0.97 to 4.91; p = 0.06). The model including 10-year Framingham CV risk and race showed good discriminatory capacity for the prediction of subclinical CV disease with an area under the ROC curve of 0.89 (95% CI, 0.85 to 0.91) [Figure 1B].

Conclusion: For the same predicted CV risk, non-Hispanic Blacks seem more vulnerable to early subclinical atherosclerosis as compare to Hispanic/Latino, placing them at enhanced risk for clinical CV disease. These results may be important for the implementation of prevention programs in different populations.