Canadian Journal of Cardiology
Clinical Research|Articles in Press

Race and Ethnicity with Atherosclerotic Cardiovascular Disease Outcomes within a Universal Healthcare System: Insights from the CARTaGENE study

Published:March 11, 2023DOI:



      It remains unclear if racial and ethnic disparities for atherosclerotic cardiovascular disease (ASCVD) persists within universal healthcare systems. We aimed to explore long-term ASCVD outcomes within a single-payer healthcare system with extensive drug coverage in Quebec, Canada.


      CARTaGENE (CaG) is a population-based prospective cohort study of individuals aged 40-69 years. We included only participants without prior ASCVD. The primary composite endpoint was time to the first ASCVD event (cardiovascular death, acute coronary syndrome, ischemic stroke/transient ischemic attack, or peripheral arterial vascular event).


      The study cohort included 18,880 participants followed for a median of 6.6 years (2009-2016). The mean age was 52 years, and 52.4% were females. After further adjustment for socioeconomic and CV factors, the increase in ASCVD risk for SAs was attenuated (HR 1.41, 95%CI 0.75, 2.67), while Black participants’ risk was lower (HR 0.52, 95%CI 0.29, 0.95) compared to White participants. After similar adjustments, there were no significant differences in ASCVD outcomes between the Middle Eastern, Hispanic, East/Southeast Asian, Indigenous, and mixed race/ethnicities participants and the White participants.


      After adjustment for CV risk factors, the risk of ASCVD was attenuated in the SA CaG participants. Intensive risk factor modification may mitigate the ASCVD risk of the SA. Within a universal health care context and comprehensive drug coverage, the ASCVD risk was lower among Black compared to the White CaG participants. Future studies are needed to confirm whether universal and liberal access to healthcare and medications can reduce the rates of ASCVD among Black individuals.



      ASCVD (Atherosclerotic Cardiovascular Disease), CaG (CARTaGENE), CV (Cardiovascular), CI (Confidence Interval), HR (Hazard Ratio)
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