Abstract：
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.
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).
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.
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.
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).
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.
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.
摘要：
背景：目前尚不清楚动脉粥样硬化性心血管疾病（ASCVD）的种族和民族差异是否在全民医疗系统中持续存在。我们的目标是在魁北克广泛的药物覆盖的单一付款人医疗保健系统中探索长期ASCVD结果。加拿大。
方法：CARTaGENE(CaG)是一项针对40-69岁人群的前瞻性队列研究。我们仅包括没有先前ASCVD的参与者。主要复合终点是第一个ASCVD事件（心血管死亡，急性冠脉综合征,缺血性卒中/短暂性脑缺血发作,或外周动脉血管事件)。
结果：该研究队列包括18,880名参与者，中位随访6.6年（2009-2016年）。平均年龄是52岁,女性占52.4%。在进一步调整社会经济和CV因素后，SAs的ASCVD风险增加减弱（HR1.41，95CI0.75，2.67），与白人参与者相比，黑人参与者的风险较低（HR0.52，95CI0.29，0.95）。经过类似的调整,中东地区的ASCVD结果没有显著差异，西班牙裔,东亚/东南亚,土著,以及混合种族/族裔参与者和白人参与者。
结论：调整CV危险因素后，SACaG参与者的ASCVD风险降低.强化危险因素修改可以减轻SA的ASCVD风险。在全民医疗保健和全面药物覆盖的背景下，与白色CaG参与者相比,黑色参与者的ASCVD风险较低.未来的研究需要确认是否普遍和自由地获得医疗保健和药物可以降低黑人个体中ASCVD的发生率。
方法：CARTaGENE(CaG)是一项针对40-69岁人群的前瞻性队列研究。我们仅包括没有先前ASCVD的参与者。主要复合终点是第一个ASCVD事件（心血管死亡，急性冠脉综合征,缺血性卒中/短暂性脑缺血发作,或外周动脉血管事件)。
结果：该研究队列包括18,880名参与者，中位随访6.6年（2009-2016年）。平均年龄是52岁,女性占52.4%。在进一步调整社会经济和CV因素后，SAs的ASCVD风险增加减弱（HR1.41，95CI0.75，2.67），与白人参与者相比，黑人参与者的风险较低（HR0.52，95CI0.29，0.95）。经过类似的调整,中东地区的ASCVD结果没有显著差异，西班牙裔,东亚/东南亚,土著,以及混合种族/族裔参与者和白人参与者。
结论：调整CV危险因素后，SACaG参与者的ASCVD风险降低.强化危险因素修改可以减轻SA的ASCVD风险。在全民医疗保健和全面药物覆盖的背景下，与白色CaG参与者相比,黑色参与者的ASCVD风险较低.未来的研究需要确认是否普遍和自由地获得医疗保健和药物可以降低黑人个体中ASCVD的发生率。
