Nurose Karim, MD
Why is there less carotid revascularization in African American and Hispanic populations despite them having greater cardiovascular risk factors? Is this due to disparities in the access to care? Or it is truly due to low incidence of severe carotid stenosis (defined as the peak systolic velocity >230 cm/sec on carotid ultrasound)? While American Heart Association and United States Preventive Services Taskforce (USPSTF) recommendations do not support the carotid screening of the general population, Life Line Screening (LLS, Independence, Ohio) is a direct-to-consumer company in which individuals can self-pay for vascular assessments if they choose.
The authors collected data from LLS for all the patients who underwent screening for carotid stenosis from 2005-2019. Data was stratified on the basis of race/ethnicity (White, Black, Hispanic, Asian, Native American or other), sex (men or women), and age (45-54, 55-64, 65-74 or 75-84 years). Patients above age 85 were excluded. This led to a total of 6,130,481 unique participants. The prevalence of high-grade carotid stenosis was significantly lower for Black, Hispanic and Asian individuals compared to White individuals. This is comparable with the data from the 2015 census for population with high-grade stenosis and reported the prevalence as 72% of the White population, with Black and Hispanic populations comprising 11% each, and women comprising 52%.