A new study reveals high levels of Lipoprotein(a) are twice as likely to contribute to atherosclerotic cardiovascular disease in Black patients compared to White patients. Dr. Jelani Grant shares other key components that might be linked to unequal rates of this type of heart disease.
Good morning. My name is Jelani Grant. I'm a second year cardiology fellow here at the Johns Hopkins Hospital. I'm originally from Trinadad and Tobago did my medical school training there, then my internal medicine and residency training at the University of Miami where I also did a chief year before coming to Hopkins. I'm gonna speak to you about our research entitled, assessing the contribution of racial differences in elevated lipoprotein A levels to disparities in arthrosclerotic cardiovascular disease. Using the ARIC study lipoprotein A is a molecule of protein that's similar to LDL cholesterol, but it's 90% genetically determined and it's associated with a higher odds or risk of aporo cardiovascular disease and aortic stenosis. Since the onset of COVID. We've noticed that there has been disparities in cardiovascular care specifically between white and nonwhite or minority populations. And we know or hypothesize that this can be due to differences in the genetic ancestry, implicit bias within the workplace or health care or differences in social determinants of health. While there has been a lot of ST in terms of social determinants of health, there has not been a lot of focus behind genetic ancestry, what we try to do is using the ARIC study, a primary prevention cohort of approximately 9000 patients, we separated them into black and white patients and these patients were followed over 20 to 25 years. As was known before we know that a higher LP level A level was again associated with a higher odds of atheros porotic cardiovascular disease and coronary heart disease against VV against varying thresholds. However, the difference is that we use a special statistical tool called the population attributor fraction where we not only use the level of value of the light protein A, but we know that there are racial differences in these levels where black patients have higher levels compared to white patients. And although that risk remains the same, we wanted to prepare a model that looked at not only the LP level A levels, but also the prevalence of a high LP level A level which gave this PAF ratio. So for example, when we looked at white patients, the contribution of LP level A to A S CV D was 5% when it came to A S CV D. But for black patients, this was 10.1% meaning that the contribution of LP level A to A S CBD was almost double that in black patients compared to white patients, especially knowing that this molecule is genetically driven when it came to coronary heart disease. This relationship was the same. So our hypothesis is while there's a lot of data and information focusing on the social determinants of health playing a key role in racial differences, which we fully agree with. There's also a smaller component that is attributed to genetic differences and ancestry between black and white patients in the United States. Thank you.
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