Canadian Multiethnicity—Differences in Coronary Artery Disease Prevalence and Progression and Relevance to Cardiac Imaging

The ethnic diversity of Canada is attributed to a steady rise in immigration, particularly from Asia. The diverse population demographics encompass a variety of cultural, linguistic, genetic, socioeconomic status, and clinical factors. The prevalence of coronary artery disease (CAD) varies among ethnic subgroups, being higher in South Asians than in Europeans and Chinese. These differences may be due to interactions among genetic and environmental factors and other factors that are still poorly understood. The predisposition and prevalence of underlying risk factors, such as hypertension, diabetes, obesity, smoking, and hyperlipidemia, also vary considerably among the different ethnic groups. An appreciation of these differences in assessing the risk of CAD is an important component of decision-making processes involving diagnosis and risk stratification of CAD in minority populations. In addition, the assessment of subclinical atherosclerosis using coronary calcium score or carotid intima media thickness as surrogate markers for atherosclerosis may allow for early and aggressive risk modification before the development of symptomatic CAD. Measures aimed at modifying these risk factors might reduce the prevalence of CAD in high-risk populations. The extent and progression of CAD may vary in these populations, resulting in perceptible differences in patient outcomes following myocardial infarction, percutaneous coronary intervention, and coronary artery bypass grafting. Ethnicity may also impact reference values of cardiac structure such as left ventricular parameters measured using echocardiography and cardiac magnetic resonance imaging. By understanding these differences, we may be able to improve health care strategies for ethnicity specific care, at primary and secondary prevention levels.