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.
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
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Canadian Journal of Cardiology
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Epidemiology of Atherosclerosis and the Potential to Reduce the Global Burden of Atherothrombotic Disease.Circ Res. 2016; 118: 535-546
- Cardiovascular Health in African Americans: A Scientific Statement From the American Heart Association.Circulation. 2017; 136: e393-e423
- Status of cardiovascular disease and stroke in Hispanics/Latinos in the United States: a science advisory from the American Heart Association.Circulation. 2014; 130: 593-625
- South Asians and cardiovascular risk: what clinicians should know.Circulation. 2006; 113: e924-929
- Environmental Determinants of Cardiovascular Disease.Circ Res. 2017; 121: 162-180
- Social Determinants of Risk and Outcomes for Cardiovascular Disease: A Scientific Statement From the American Heart Association.Circulation. 2015; 132: 873-898
- Canada's universal health-care system: achieving its potential.The Lancet. 2018; 391: 1718-1735
- Evaluating the effects of Quebec's private-public drug insurance system.CMAJ. 2017; 189: E1259-E1263
- Comparison of cardiovascular risk profiles among ethnic groups using population health surveys between 1996 and 2007.CMAJ. 2010; 182: E301-310
- Cohort profile of the CARTaGENE study: Quebec's population-based biobank for public health and personalized genomics.Int J Epidemiol. 2013; 42: 1285-1299
- The Groundwater of Racial and Ethnic Disparities Research: A Statement From Circulation: Cardiovascular Quality and Outcomes.Circ Cardiovasc Qual Outcomes. 2021; 14e007868
- The Incidence of Major Cardiovascular Events in Immigrants to Ontario, Canada: The CANHEART Immigrant Study.Circulation. 2015; 132: 1549-1559
- Updated Guidance on the Reporting of Race and Ethnicity in Medical and Science Journals.JAMA. 2021; 326: 621-627
- Implementation of ICD-10 in Canada: how has it impacted coded hospital discharge data?.BMC Health Services Research. 2012; 12: 1-9
- Comparison and Validity of Procedures Coded With ICD-9-CM and ICD-10-CA/CCI.Medical Care. 2008; 46
- Québec Integrated Chronic Disease Surveillance System (QICDSS), an innovative approach.Chronic Diseases and Injuries in Canada. 2014; 34: 226-235
Fréchet G, Lanctôt P, Morin A. Prendre la mesure de la pauvreté. Québec2009:1-75.
Rubin D. Multiple Imputations for Nonresponse in Surveys. New York: John Wiley & Sons; 2008.
- Introduction to the Analysis of Survival Data in the Presence of Competing Risks.Circulation. 2016; 133: 601-609
Cooper RS, Kaufman JS, Ward R. Race and Genomics. New England Journal of Medicine. 2003;348.
- Racial Disparities in Acute Coronary Syndrome Management Within a Universal Healthcare Context: Insights From the AMI-OPTIMA Trial.CJC Open. 2021; 3: S28-S35
- Cardiovascular disease, diabetes and established risk factors among populations of sub-Saharan African descent in Europe: a literature review.Global Health. 2009; 5: 7
- Ethnic Differences in Cardiovascular Disease Risk Factors: A Systematic Review of North American Evidence.Can J Cardiol. 2015; 31: 1169-1179
- The Burden of Atherosclerotic Cardiovascular Disease in South Asians Residing in Canada: A Reflection From the South Asian Heart Alliance.CJC Open. 2019; 1: 271-281
- Cardiovascular risk among South Asians living in Canada: a systematic review and meta-analysis.CMAJ Open. 2014; 2: E183-191
- Prevalence of cardiovascular risk factors in the Middle East: a systematic review.Eur J Cardiovasc Prev Rehabil. 2009; 16: 268-280
- Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association.Circulation. 2022; 145: e153-e639
- Temporal trends in cardiovascular disease risk factors among white, South Asian, Chinese and black groups in Ontario, Canada, 2001 to 2012: a population-based study.BMJ Open. 2015; 5e007232
- Cardiovascular disease and risk factors in Asia: a selected review.Circulation. 2008; 118: 2702-2709
- Evaluation of care and surveillance of cardiovascular disease: can we trust medico-administrative hospital data?.Can J Cardiol. 2012; 28: 162-168
Accepted: March 7, 2023
Received in revised form: February 20, 2023
Received: October 23, 2022
Publication stageIn Press Journal Pre-Proof
© 2023 Published by Elsevier Inc. on behalf of the Canadian Cardiovascular Society.