University of Maryland School of Medicine, Baltimore VA Medical Center (B.K.L., A.L.).
Mayo Clinic, Jacksonville, FL (J.F.M., T.G.B.).
Stroke. 2021 Jun;52(6):2053-2059. doi: 10.1161/STROKEAHA.120.032723. Epub 2021 May 4.
Despite a higher incidence of stroke and a more adverse cardiovascular risk factor profile in Blacks and Hispanics compared with Whites, carotid artery revascularization is performed less frequently among these subpopulations. We assessed racial differences in high-grade (≥70% diameter-reducing) carotid stenosis.
Consecutive clients in a Nationwide Life Line for-Profit Service to screen for vascular disease, 2005 to 2019 were evaluated in a cross-sectional study. The prevalence of high-grade stenosis, defined by a carotid ultrasound peak systolic velocity of ≥230 cm/s, was assessed. Participants self-identified as White, Black, Hispanic, Asian, Native American, or other. Race/ethnic differences were assessed using Poisson regression. The number of individuals in the United States with high-grade stenosis was estimated by applying prevalence estimates to 2015 US Census population estimates.
The prevalence of high-grade carotid stenosis was estimated in 6 130 481 individuals. The prevalence of high-grade stenosis was higher with increasing age in all race-sex strata. Generally, Blacks and Hispanics had a lower prevalence of high-grade stenosis compared with Whites, while Native Americans had a higher prevalence. For example, for men aged 55 to 65, the relative risk of stenosis compared with Whites was 0.40 (95% CI, 0.29–0.55) and 0.61 (95% CI, 0.46–0.81) for Blacks and Hispanics, respectively; and 1.53 (95% CI, 1.12–2.10) for Native Americans. When these prevalence estimates were applied to the Census estimates of the US population, an estimated 327 721 individuals have high-grade stenosis, of whom 7% are Black, 7% Hispanic, and 43% women.
Despite their having a more adverse cardiovascular risk profile, there was a lower prevalence of high-grade carotid artery stenosis for both the Black and Hispanic relative to the White clients. This lower prevalence of high-grade stenosis is a potential contributor to the lower use of carotid revascularization procedures in these minority populations.
尽管黑人和西班牙裔人群的中风发病率更高，心血管风险因素谱也更为不利，但与白人相比，这些人群接受颈动脉血运重建术的频率却较低。我们评估了不同种族间重度（≥70%管径狭窄）颈动脉狭窄的差异。
在一项横断面研究中，对 2005 年至 2019 年全国生命线营利性服务中连续筛查血管疾病的患者进行评估。通过颈动脉超声检测收缩期峰值速度≥230cm/s 来评估重度狭窄的患病率。参与者自报为白人、黑人、西班牙裔、亚裔、美国原住民或其他。采用泊松回归评估种族/民族差异。应用患病率估计值对 2015 年美国人口普查人口估计值进行计算，从而估算出美国患有重度狭窄的人数。
本研究估计了 6130481 例个体的重度颈动脉狭窄患病率。所有种族-性别分层中，随着年龄的增长，重度狭窄的患病率逐渐升高。一般来说，与白人相比，黑人及西班牙裔人群的重度狭窄患病率较低，而美国原住民的患病率较高。例如，对于年龄在 55 岁至 65 岁的男性，与白人相比，黑人的狭窄相对风险为 0.40（95%CI，0.290.55），西班牙裔为 0.61（95%CI，0.460.81）；美国原住民为 1.53（95%CI，1.12~2.10）。当这些患病率估计值应用于美国人口普查的人口估计值时，估计有 327721 例患者患有重度狭窄，其中 7%为黑人，7%为西班牙裔，43%为女性。
尽管黑人和西班牙裔人群的心血管风险谱更为不利，但与白人患者相比，黑人及西班牙裔人群的重度颈动脉狭窄的患病率较低。重度颈动脉狭窄患病率较低可能是导致这些少数族裔人群较少接受颈动脉血运重建术的原因之一。
