TY - JOUR AU - Kataoka, Yu AU - Hsu, Amy AU - Wolski, Kathy AU - Uno, Kiyoko AU - Puri, Rishi AU - Tuzcu, E. Murat AU - Nissen, Steven E. AU - Nicholls, Stephen J. PY - 2013 TI - Progression of coronary atherosclerosis in African-American patients JF - Cardiovascular Diagnosis and Therapy; Vol 3, No 3 (September 29, 2013): Cardiovascular Diagnosis and Therapy Y2 - 2013 KW - N2 - Background: African-Americans with coronary artery disease (CAD) demonstrate worse clinical outcomes than Caucasians. While this is partly due to a lack of accessibility to established therapies, the mechanisms underlying this difference remain to be elucidated. We aimed to characterize the progression of coronary atherosclerosis in African-Americans with CAD. Methods: 3,479 patients with CAD underwent serial intravascular ultrasound (IVUS) imaging to evaluate atheroma progression in 7 clinical trials of anti-atherosclerotic therapies. Risk factor control and atheroma progression were compared between African-Americans (n=170) and Caucasians (n=3,309). Results: African-Americans were more likely to be female (51.8% vs. 28.1%, P<0.001), have a higher body mass index (32.8±6.0 vs. 31.3±5.8 kg/m2, P=0.002) and greater history of hypertension (85.9% vs. 78.8%, P=0.02), diabetes (41.8% vs. 30.6%, P=0.002) and stroke (12.9% vs. 3.0%, P<0.001). Despite a high use of anti-atherosclerotic medications (93% statin, 89% aspirin, 79% β-blocker, 52% ACE inhibitor), African- Americans demonstrated higher levels of LDL-C (2.4±0.7 vs. 2.2±0.7 mmol/L, P=0.006), CRP (2.9 vs. 2.0 mg/dL, P<0.001) and systolic blood pressure (133±15 vs. 129±13 mmHg, P<0.001) at follow-up. There was no significant difference in atheroma volume at baseline (189.0±82.2 vs. 191.6±83.3 mm 3 , P=0.82) between two groups. Serial evaluation demonstrated a greater increase in atheroma volume in African- Americans (0.51±2.1 vs. –3.1±1.7 mm 3 , P=0.01). This difference persisted with propensity matching accounting for differences in risk factor control (0.1±2.1 vs. –3.7±1.7 mm 3 , P=0.02). Conclusions: African-Americans with CAD achieve less optimal risk factor control and greater atheroma progression. These findings support the need for more intensive risk factor modification in African- Americans. UR - https://cdt.amegroups.org/article/view/2703