Abstract
Introduction
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.
Methods
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).
Results
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.
Conclusion
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.
Keywords
Abbreviations:
ASCVD (Atherosclerotic Cardiovascular Disease), CaG (CARTaGENE), CV (Cardiovascular), CI (Confidence Interval), HR (Hazard Ratio)To read this article in full you will need to make a payment
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Article info
Publication history
Accepted:
March 7,
2023
Received in revised form:
February 20,
2023
Received:
October 23,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Published by Elsevier Inc. on behalf of the Canadian Cardiovascular Society.
