Friday, January 27, 2023
Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™
ABIM Diplomates - maximum of 0.25 ABIM MOC points
Nurses - 0.25 ANCC Contact Hour(s) (0 contact hours are in the area of pharmacology)
IPCE - 0.25 Interprofessional Continuing Education (IPCE) credit
This activity is intended for cardiologists, emergency medicine clinicians, family medicine/primary care clinicians, internists, nurses, and other members of the health care team who treat and manage patients with high cardiovascular disease burden.
The goal of this activity is to describe differences in cardiovascular disease risk burden, coronary plaque, and major adverse cardiac events between non-Hispanic Black and non-Hispanic White individuals assigned to receive coronary computed tomography angiography or functional testing for stable chest pain, based on a nested observational cohort study within the Prospective Multicenter Imaging Study for Evaluation of Chest Pain trial.
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CME / ABIM MOC / CE Released: 2/11/2022
Valid for credit through: 2/11/2023
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Higher incidence of long-term coronary artery disease (CAD) complications in Blacks than in Whites may result from higher burden of cardiovascular disease (CVD) risk factors and differences in socioeconomic and health care delivery factors. Coronary computed tomography angiography (CCTA) is a noninvasive imaging test that can directly visualize coronary plaque, the extent of which estimates the probability of major adverse cardiac events (MACE).
Black adults with chest pain have a higher burden of CVD risk factors compared with White adults, but they have a similarly low incidence of MACE over the course of 2 years, new data from the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) trial suggest.
Black adults tend to have a higher incidence of long-term CAD morbidity and mortality compared with White adults--differences that may be a result of a higher burden of CVD risk factors as well as disparities in socioeconomic status and access to healthcare.
Yet how CVD risk factors, epicardial CAD, and cardiac events differ between Black and White adults undergoing noninvasive testing for CAD is unclear.
To investigate, researchers did a post hoc analysis of 1071 Black adults (mean age, 59 years; 60% women) and 7693 non-Hispanic White adults (mean age, 61 years; 52% women) with stable chest pain who underwent CCTA for suspected CAD as part of the previously reported PROMISE trial.
The study, by Lili Zhang, MD, from the Cardiovascular Imaging Research Center, Massachusetts General Hospital, Boston, and colleagues, was published online December 22 in JAMA Cardiology.
Black adults had a higher CV risk burden than White adults, including significantly higher body mass index (32.3 vs 30.4 kg/m2; P<.001), more hypertension (82.6% vs 62.6%; P<.001), diabetes (32.2% vs 18.4%; P<.001), CAD risk equivalent (36.2% vs 22.4%; P<.001), metabolic syndrome (43.5% vs 36.4%; P<.001), and a sedentary lifestyle (58.4% vs 47.4; P<.001).
Overall, the average number of reported CV risk factors per patient was significantly higher in Black individuals compared with White patients (2.47 vs 2.35; P<.001).
Yet despite the significantly higher CV risk burden, Black and White persons had a "similarly low" rate of MACE during a median follow-up of 24.4 months (3.0% vs 3.2%; P=.84), Dr Zhang and colleagues report.
Sensitivity analyses restricted to the 79.8% of participants with a normal or mildly abnormal noninvasive CCTA result and the 54.3% not receiving statin therapy yielded similar findings.
Significant coronary stenosis and high-risk plaque were associated with MACE in both Black and White patients.
However, with respect to epicardial CAD burden, Black patients had a less-prevalent coronary artery calcium score higher than 0 (45.1% vs 63.2%; P<.001), coronary stenosis at least 50% (8.7% vs 14.6%; P=.001), and high-risk plaque (37.6% vs 52.4%; P<.001).
The finding that Black individuals had more CV risk factors yet less coronary plaque on CCTA and similar MACE at 2 years "underscores the limits of our understanding of the relationship between risk factors and plaque in Black and White persons," write Dr Zhang and colleagues.
They caution that although the PROMISE trial included a diverse pool of patients with suspected CAD, it may not reflect the broader population in whom CAD is not suspected.
Also, the number of Black participants included was modest and follow-up was limited to 24 months. Therefore, the results should be interpreted in the context of 2-year MACE and may not capture differences that would emerge over the course of 10 years, the study team says.
Finally, they say the study may be underpowered to detect the differences in MACE between Black and White individuals because of the low rate of MACE.
The PROMISE study was funded by National Heart, Lung, and Blood Institute.
JAMA Cardiol. Published online December 22, 2021.[1]
