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Clinical Research|Articles in Press

Race and Ethnicity With Atherosclerotic Cardiovascular Disease Outcomes Within a Universal Health Care System: Insights From the CARTaGENE Study

Published:March 11, 2023DOI:https://doi.org/10.1016/j.cjca.2023.03.007

      Abstract

      Background

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

      Methods

      CARTaGENE (CaG) is a population-based prospective cohort study of individuals aged 40 to 69 years. We included only participants without previous 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).

      Results

      The study cohort included 18,880 participants followed for a median of 6.6 years (2009 to 2016). The mean age was 52 years, and 52.4% were female. After further adjustment for socioeconomic and cardiovascular factors, the increase in ASCVD risk for South Asians (SAs) was attenuated (hazard ratio [HR], 1.41; 95% confidence interval [CI], 0.75, 2.67), whereas Black participants’ risk was lower (HR, 0.52; 95% CI, 0.29, 0.95) compared with White participants. After similar adjustments, there were no significant differences in ASCVD outcomes among the Middle Eastern, Hispanic, East-Southeast Asian, Indigenous, and mixed race-ethnicities participants and the White participants.

      Conclusions

      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 SAs. Within a universal health care context and comprehensive drug coverage, the ASCVD risk was lower among Black compared with White CaG participants. Future studies are needed to confirm whether universal and liberal access to health care and medications can reduce the rates of ASCVD among the Black population.

      Résumé

      Contexte

      Des doutes subsistent quant à la persistance des disparités raciales et ethniques en matière de maladies cardiovasculaires athéroscléreuses (MCVA) dans les systèmes de soins de santé universels. Nous avons voulu étudier les issues à long terme des MCVA au sein d’un système de soins de santé à payeur unique avec une couverture étendue des médicaments, en l’occurrence au Québec (Canada).

      Méthodologie

      CARTaGENE (CaG) est étude de cohorte prospective menée auprès d’une population d’individus âgés de 40 à 69 ans. Seuls les participants sans MCVA antérieure ont été inclus. Le critère composé principal était le temps écoulé avant le premier événement de MCVA (décès d’origine cardiovasculaire, syndrome coronarien aigu, accident vasculaire cérébral ischémique, accident ischémique transitoire ou maladie artérielle périphérique).

      Résultats

      La cohorte comprenait 18 880 participants suivis pendant une durée médiane de 6,6 ans (de 2009 à 2016). L’âge moyen était de 52 ans, et 52,4 % des sujets étaient des femmes. Après un ajustement supplémentaire pour tenir compte des facteurs socio-économiques et cardiovasculaires, la hausse du risque de MCVA chez les Sud-Asiatiques a été atténuée (rapport des risques instantanés [RRI] : 1,41; intervalle de confiance [IC] à 95 % : 0,75-2,67), tandis que le risque était plus faible pour les participants noirs (RRI : 0.52 ; IC à 95 % : 0,29-0,95) que pour les participants blancs. Après des ajustements similaires, aucune différence significative n’a été observée quant aux cas de MCVA entre les participants du Moyen-Orient, les Hispaniques, les Asiatiques de l’Est et du Sud-Est, les Autochtones et les participants de race mixte ou les participants blancs.

      Conclusions

      Après un ajustement pour tenir compte de facteurs de risque cardiovasculaire, le risque de MCVA était atténué chez les Sud-Asiatiques de l’étude CaG. Une modification intensive des facteurs de risque peut expliquer la baisse observée dans cette population. Dans le contexte d’un système de soins de santé universel offrant une couverture complète des médicaments, le risque de MCVA était par ailleurs plus faible chez les participants noirs que chez les participants blancs de l’étude CaG. D’autres études sont toutefois requises pour vérifier si un accès libre et universel aux soins de santé et aux médicaments peut expliquer la réduction des taux de MCVA au sein de la population noire.
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