Study: Higher CVD risk factors in Black patients may not mean higher cardiac event rates

Adult black male clenches his hands on his chest while experiencing severe pain.

Black patients with chest pain tend to have more risk factors for cardiovascular disease (CVD) compared to white patients, but they both have a similarly low incidence of major adverse cardiac events over a two-year period, according to researchers. The study is the first to compare CVD risk factors and major adverse cardiac events between black and white individuals, they said. 
Researchers have known for some time that Black individuals tend to have a higher incidence of long-term coronary artery disease prevalence and death compared to white individuals. Researchers have speculated that a higher burden of CVD risk factors and disparities in socioeconomic status and healthcare may play a role.  But little is known about how CVD risk factors and cardiac events differ between Blacks and white patients undergoing noninvasive testing for coronary artery disease.  

In the observational study, researchers examined data from 8,764 people enrolled in the PROMISE trial (Prospective Multicenter Imaging Study for Evaluation of Chest Pain), which compares black and white outpatients undergoing noninvasive testing for suspected coronary artery diseases.  The researchers looked at cardiovascular risk burden, major adverse cardiac events, and coronary plaque features among the participants, which included 1,071 Black individuals and 7,693 white individuals.   

The researchers found that Black individuals had a higher cardiovascular risk burden, including more hypertension and diabetes, over the two-year follow-up period based on cardiovascular imaging. However, the Black participants tended to have lower rates of coronary artery calcium, stenosis, and high-risk plaque than the white participant.  And despite Black individuals having a higher CVD burden, both groups had a similarly low major adverse events rate over this period.  

The study underscores the need for a better understanding of the relationship between risk factors and plaque in Black and white individuals, they said. The study, funded by the NHLBI, appeared in JAMA Cardiology.