Abstract 10410: Association Between Coronary Artery Calcium Scoring With Statin Initiation, Cholesterol Reduction and Cardiovascular Outcomes in Black Patients

Abstract

Introduction: Coronary artery calcium (CAC) scoring is a cost-effective and reproducible method to assess risk for cardiovascular (CV) outcomes and is particularly important for guiding prevention in asymptomatic patients. Black patients are at high risk for atherosclerotic cardiovascular disease (ASCVD) that is not fully explained by traditional risk factors. In this study, we investigated the prevalence of CAC and its association with CV events in Black and white individuals. Methods: We investigated the baseline characteristics, rates of statin initiation, changes in cholesterol, and major adverse CV events (myocardial infarction, stroke, death) in 49,799 patients with self-reported race (Black or white) who underwent CAC scoring in the CLARIFY study between 2014 and 2020 (Clinicaltrials.gov NCT04075162). Results: In total, there were 4,292 Black patients and 45,507 white patients. Compared with white patients, Black patients had similar age (P=0.17), were more likely to be female (60.5% vs 50%, P<0.001), had higher 10-year ASCVD risk by pooled cohort equation (16.18% vs. 11.06%, P<0.001), lower LDL cholesterol (115 vs 123 mg/dL, P<0.001), and were more likely to have CAC of 0 (49.2% vs 39.9%, P<0.001). At every 10-year ASCVD risk category by pooled cohort equation, CAC was more prevalent in white patients than Black patients (p<0.001). Despite similar statin initiation post CAC score in patients not on statins at baseline, Black patients had less relative reduction in LDL cholesterol over 1 year compared with white patients (figure). Within each CAC category, Black patients had higher rates of CV events (P<0.003) over 1 year. Conclusions: In this large cohort of patients undergoing CAC scoring, Black individuals had lower CAC scores despite having higher predicted ASCVD risk and worse outcomes. Black individuals had less relative reduction in cholesterol over 1 year compared with white individuals, despite having similar statin initiation rates.