Available online 9 April 2025

Author links open overlay panel, , , , , , , , , , , , AbstractBackground

Despite an increasingly diverse population, knowledge regarding racial and ethnic disparities is limited among women and men undergoing atherosclerotic cardiovascular (ASCVD) risk assessment.

Objectives

The aim of this study was to compare cardiovascular (CV) mortality by ASCVD risk and coronary artery calcium (CAC) scores among Black and Hispanic women and men compared with other participants.

Methods

From the CAC Consortium, 42,964 participants with self-reported race and ethnicity were followed for a median of 11.7 years. Multivariable Cox proportional hazards regression models were used to estimate CV mortality, with separate analyses by sex.

Results

One-third of enrollees were women; 977 self-reported as Black, 1,349 as Hispanic, 1,621 as Asian, and 740 as American Indian/Native Alaskan/Hawaiian or unspecified; the remainder were White. Black women and men had higher ASCVD risk and CAC scores yielding the highest CV mortality compared with other participants. Among Black women and men with a 0 CAC or ASCVD risk score <5%, HRs were 6- to 9-fold higher than that of other women and men. In men with CAC scores ≥100, Black men (HR: 4.2; P < 0.001) had the highest CV mortality compared to all other men. A similar high-risk pattern was noted for Black women with CAC scores ≥100 (P < 0.001), even with adjustment for the ASCVD risk score. Overall, Hispanics had an intermediate CV mortality, less than that of Black participants. This was notable for Hispanic men with a CAC score of 0 (HR: 3.6; P = 0.006) and CAC ≥100 (HR: 2.3; P = 0.03).

Conclusions

The disproportionately high and excess CV mortality among Black women and men represents significant barriers to reducing the burden of ASCVD through effective risk assessment using ASCVD risk and CAC scores.

Central IllustrationDownload: Download high-res image (891KB)Download: Download full-size imageSection snippetsCAC Consortium Enrollment and Study Population

Details of the CAC Consortium have been previously published.2,3 Participants were included in this study if they were ≥18 years of age, asymptomatic, and had no history of CAD at the time of their index CAC scan. For this report, we included 42,964 participants (from 3 of the 4 sites) with self-reported race and ethnicity. From this subset, 977 self-reported as Black, 1,349 as Hispanic, 1,621 as Asian, 740 as other (ie, 165 self-reported as American Indian, Alaskan Native, or Native

Baseline Cardiac Risk Factors and ASCVD Risk Scores

Tables 1 and 2 provide descriptive statistics for enrollees in the CAC Consortium. Approximately one-third of enrollees were women with a mean age of 54.7 years. Across the diverse groups, women were generally older than men at the time of their CAC scan. It is notable that hypertension was most prevalent in Black women (60.9%) as compared with other subsets of women. Moreover, Black women had a high rate of smoking (13.8%) and diabetes (16.1%), and were more often obese (39.8%). Hispanic women

Discussion

Profound racial and ethnic disparities represent significant barriers to reducing the burden of CV disease through lifesaving preventive care. Detection of atherosclerosis is the basis for guiding primary prevention,25 with CAC scanning becoming an ever-important part of the risk assessment process, especially among individuals where CV risk is uncertain or when significant evidence gaps exist among key, diverse populations.4,26, 27, 28, 29 For CAC, the evidence among racially and ethnically

Conclusions

With an ever-increasing diversity in our patient population, there is a growing need for greater evidence regarding effective strategies for assessment of CV risk. Both the ASCVD risk score and CAC scan are commonly used approaches and integral for guiding intensification or de-escalation of preventive therapies.25 Our results confirm the need for a deeper knowledge of racial and ethnic differences in CV screening especially for the optimal timing of CV screening for higher risk Black women and

Funding Support and Author Disclosures

This work was funded by the Blavatnik Family Research Institute. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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© 2025 by the American College of Cardiology Foundation. Published by Elsevier.