Brajesh K Lal1, James F Meschia2, Thomas G Brott2, Michael Jones3, Herbert D Aronow4, Angelica Lackey1, George Howard5. 1. University of Maryland School of Medicine, Baltimore VA Medical Center (B.K.L., A.L.). 2. Mayo Clinic, Jacksonville, FL (J.F.M., T.G.B.). 3. Baptist Health, Lexington, KY (M.J.). 4. Alpert Medical School of Brown University, Providence, RI (H.D.A.). 5. University of Alabama at Birmingham (G.H.).
Abstract
Background and Purpose: Despite a higher incidence of stroke and a more adverse cardiovascular risk factor profile in Blacks and Hispanics compared with Whites, carotid artery revascularization is performed less frequently among these subpopulations. We assessed racial differences in high-grade (≥70% diameter-reducing) carotid stenosis. Methods: Consecutive clients in a Nationwide Life Line for-Profit Service to screen for vascular disease, 2005 to 2019 were evaluated in a cross-sectional study. The prevalence of high-grade stenosis, defined by a carotid ultrasound peak systolic velocity of ≥230 cm/s, was assessed. Participants self-identified as White, Black, Hispanic, Asian, Native American, or other. Race/ethnic differences were assessed using Poisson regression. The number of individuals in the United States with high-grade stenosis was estimated by applying prevalence estimates to 2015 US Census population estimates. Results: The prevalence of high-grade carotid stenosis was estimated in 6 130 481 individuals. The prevalence of high-grade stenosis was higher with increasing age in all race-sex strata. Generally, Blacks and Hispanics had a lower prevalence of high-grade stenosis compared with Whites, while Native Americans had a higher prevalence. For example, for men aged 55 to 65, the relative risk of stenosis compared with Whites was 0.40 (95% CI, 0.29–0.55) and 0.61 (95% CI, 0.46–0.81) for Blacks and Hispanics, respectively; and 1.53 (95% CI, 1.12–2.10) for Native Americans. When these prevalence estimates were applied to the Census estimates of the US population, an estimated 327 721 individuals have high-grade stenosis, of whom 7% are Black, 7% Hispanic, and 43% women. Conclusions: Despite their having a more adverse cardiovascular risk profile, there was a lower prevalence of high-grade carotid artery stenosis for both the Black and Hispanic relative to the White clients. This lower prevalence of high-grade stenosis is a potential contributor to the lower use of carotid revascularization procedures in these minority populations.
Background and Purpose: Despite a higher incidence of stroke and a more adverse cardiovascular risk factor profile in Blacks and Hispanics compared with Whites, carotid artery revascularization is performed less frequently among these subpopulations. We assessed racial differences in high-grade (≥70% diameter-reducing) carotid stenosis. Methods: Consecutive clients in a Nationwide Life Line for-Profit Service to screen for vascular disease, 2005 to 2019 were evaluated in a cross-sectional study. The prevalence of high-grade stenosis, defined by a carotid ultrasound peak systolic velocity of ≥230 cm/s, was assessed. Participants self-identified as White, Black, Hispanic, Asian, Native American, or other. Race/ethnic differences were assessed using Poisson regression. The number of individuals in the United States with high-grade stenosis was estimated by applying prevalence estimates to 2015 US Census population estimates. Results: The prevalence of high-grade carotid stenosis was estimated in 6 130 481 individuals. The prevalence of high-grade stenosis was higher with increasing age in all race-sex strata. Generally, Blacks and Hispanics had a lower prevalence of high-grade stenosis compared with Whites, while Native Americans had a higher prevalence. For example, for men aged 55 to 65, the relative risk of stenosis compared with Whites was 0.40 (95% CI, 0.29–0.55) and 0.61 (95% CI, 0.46–0.81) for Blacks and Hispanics, respectively; and 1.53 (95% CI, 1.12–2.10) for Native Americans. When these prevalence estimates were applied to the Census estimates of the US population, an estimated 327 721 individuals have high-grade stenosis, of whom 7% are Black, 7% Hispanic, and 43% women. Conclusions: Despite their having a more adverse cardiovascular risk profile, there was a lower prevalence of high-grade carotid artery stenosis for both the Black and Hispanic relative to the White clients. This lower prevalence of high-grade stenosis is a potential contributor to the lower use of carotid revascularization procedures in these minority populations.
Authors: Siddharth A Wayangankar; Kevin F Kennedy; Herbert D Aronow; John Rundback; Alfonso Tafur; Douglas Drachman; Bhavin Patel; Chittur A Sivaram; Faisal Latif Journal: Stroke Date: 2015-05-07 Impact factor: 7.914
Authors: Caron B Rockman; Han Hoang; Yu Guo; Thomas S Maldonado; Glenn R Jacobowitz; Toghrul Talishinskiy; Thomas S Riles; Jeffrey S Berger Journal: J Vasc Surg Date: 2012-11-22 Impact factor: 4.268
Authors: Louai Razzouk; Caron B Rockman; Manesh R Patel; Yu Guo; Mark A Adelman; Thomas S Riles; Jeffrey S Berger Journal: Atherosclerosis Date: 2015-06-23 Impact factor: 5.162
Authors: Larry B Goldstein; David B Matchar; Jennifer Hoff-Lindquist; Gregory P Samsa; Ronnie D Horner Journal: Stroke Date: 2003-03-20 Impact factor: 7.914
Authors: Hilary A Brown; Michael C Sullivan; Richard G Gusberg; Alan Dardik; Julie Ann Sosa; Jeffrey E Indes Journal: J Vasc Surg Date: 2013-01-30 Impact factor: 4.268
Authors: Alice J Sheffet; George Howard; Albert Sam; Zafar Jamil; Fred Weaver; David Chiu; Jenifer H Voeks; Virginia J Howard; Susan E Hughes; Linda Flaxman; Mary E Longbottom; Thomas G Brott Journal: Stroke Date: 2017-11-30 Impact factor: 7.914
Authors: D H O'Leary; J F Polak; R A Kronmal; S J Kittner; M G Bond; S K Wolfson; W Bommer; T R Price; J M Gardin; P J Savage Journal: Stroke Date: 1992-12 Impact factor: 7.914
Authors: Daniela Renedo; Julián N Acosta; Nanthiya Sujijantarat; Joseph P Antonios; Andrew B Koo; Kevin N Sheth; Charles C Matouk; Guido J Falcone Journal: Stroke Date: 2022-02-03 Impact factor: 10.170