Racial Differences in Atherosclerosis, Plaque Vulnerability, and CVD

Summary

Principal Investigator: Steven Reis
Abstract: Cardiovascular disease (CVD) is the leading cause of death in the United States. Blacks are affected disproportionately by CVD;age-adjusted coronary heart disease death rates are 29% higher for blacks than for whites. This disparity in risk is only partially explained by racial differences in prevalences of traditional and emerging CVD risk factors. Despite having higher rates of CVD, blacks are less likely than whites to have severe obstructive coronary artery atherosclerosis and coronary artery calcium. This observation is counterintuitive;the less diffuse coronary artery calcification and obstruction observed in blacks would be expected to be associated with a lower prevalence of CVD risk factors and a lower incidence of CVD events, neither of which is observed. In the face of these inconsistencies, we hypothesize that as compared to whites, blacks are more likely to develop vulnerable atherosclerotic plaques that are associated with acute CVD. Our preliminary investigations support this hypothesis by demonstrating that black race is independently associated with less calcified coronary artery plaques, greater positive arterial remodeling, and more endothelial dysfunction. Racial differences in these arterial characteristics, which are associated with increased plaque vulnerability, may be explained by our observations which indicate that blacks have higher levels of circulating modulators of plaque vulnerability. Therefore, the goal of the proposed study is to prospectively investigate race-related differences in the pathophysiology of atherosclerotic plaques in our extensively characterized cohort of 2,000 subjects (43% black) in our Heart SCORE study that has collected a wealth of biological data and plasma over a follow-up period of 6 years. This proposal will compare the prevalence of vulnerable atherosclerotic plaque between blacks and whites who are enrolled in Heart SCORE by using microbubble contrast-enhanced B-mode ultrasonography to quantify carotid artery adventitial vasa vasorum density, which correlates with plaque vulnerability, and to accurately measure intimal-medial thickness of both the far and near walls of the carotid artery (cIMT). The proposed study will also evaluate race-related differences in distributions of modulators of plaque vulnerability, such as inflammatory mediators, matrix metalloproteinases, and markers of endothelial cell activation, and in the predictive value of these modulators for long-term risk of adverse CVD events. Moreover, the study will assess the predictive values of vasa vasorum density and modulators of plaque vulnerability for cIMT (including by race). We anticipate that our findings will demonstrate a link between race, vasa vasorum density, atherosclerosis modulators, and CVD outcome. This finding would suggest that racial disparities in CVD are related, at least in part, to race-related differences in the pathophysiology of atheroscleros
Funding Period: ----------------2009 - ---------------2011-
more information: NIH RePORT

Top Publications

  1. pmc Sociodemographic, clinical, and psychological factors associated with attrition in a prospective study of cardiovascular prevention: the Heart Strategies Concentrating on Risk Evaluation study
    Claudia E Bambs
    School of Medicine, Pontificia Universidad Catolica de Chile, Chile
    Ann Epidemiol 23:328-33. 2013
  2. ncbi Relationship among low cholesterol levels, depressive symptoms, aggression, hostility, and cynicism
    Frances M Sahebzamani
    College of Nursing, University of South Florida, 12901 Bruce B Downs Boulevard, MDN, Room 2010, Tampa, FL 33612 4476, USA
    J Clin Lipidol 7:208-16. 2013
  3. pmc Traditional and nontraditional cardiovascular risk factors in comorbid insomnia and sleep apnea
    Faith S Luyster
    School of Nursing, University of Pittsburgh, Pittsburgh, PA
    Sleep 37:593-600. 2014
  4. pmc Low prevalence of "ideal cardiovascular health" in a community-based population: the heart strategies concentrating on risk evaluation (Heart SCORE) study
    Claudia Bambs
    University of Pittsburgh, Pittsburgh, PA 15261, USA
    Circulation 123:850-7. 2011

Scientific Experts

  • Steven Reis
  • Kevin E Kip
  • Aryan N Aiyer
  • Faith S Luyster
  • Claudia E Bambs
  • Frances M Sahebzamani
  • Suresh R Mulukutla
  • Claudia Bambs
  • Patrick J Strollo
  • Daniel J Buysse
  • Karen Matthews
  • Rita F D'Aoust
  • Debra Friedrich
  • Lee Ann McDowell
  • Cheryl Johnson
  • Andrea Dinga

Detail Information

Publications4

  1. pmc Sociodemographic, clinical, and psychological factors associated with attrition in a prospective study of cardiovascular prevention: the Heart Strategies Concentrating on Risk Evaluation study
    Claudia E Bambs
    School of Medicine, Pontificia Universidad Catolica de Chile, Chile
    Ann Epidemiol 23:328-33. 2013
    ..To identify factors associated with attrition in a longitudinal study of cardiovascular prevention...
  2. ncbi Relationship among low cholesterol levels, depressive symptoms, aggression, hostility, and cynicism
    Frances M Sahebzamani
    College of Nursing, University of South Florida, 12901 Bruce B Downs Boulevard, MDN, Room 2010, Tampa, FL 33612 4476, USA
    J Clin Lipidol 7:208-16. 2013
    ..However, naturally low or therapeutically reduced cholesterol levels may be associated with adverse psychological health symptoms, including depression, aggression, and hostility...
  3. pmc Traditional and nontraditional cardiovascular risk factors in comorbid insomnia and sleep apnea
    Faith S Luyster
    School of Nursing, University of Pittsburgh, Pittsburgh, PA
    Sleep 37:593-600. 2014
    ..The current study examined traditional risk factors and a physiologic biomarker of cardiovascular risk in comorbid insomnia and sleep apnea...
  4. pmc Low prevalence of "ideal cardiovascular health" in a community-based population: the heart strategies concentrating on risk evaluation (Heart SCORE) study
    Claudia Bambs
    University of Pittsburgh, Pittsburgh, PA 15261, USA
    Circulation 123:850-7. 2011
    ..The applicability of this construct to community-based populations and the distributions of its components by race and sex have not been reported...