MUNICH - A joint Swedish and U.K. study involving CT angiography and calcium scoring has found that angina patients of South Asian origin have more aggressive and diffuse arterial calcification compared with Caucasians, especially those older than age 50.
Ethnic differences in the prevalence and severity of coronary artery disease (CAD) or coronary artery calcification (CAC) have been noted, Dr. George Koulaouzidis from the Heart Centre and the department of public health and clinical medicine at Umeå University in Sweden, reported at this week's European Society of Cardiology (ESC) annual meeting. South Asians are one of the largest ethnic groups at risk of CAD, but they are underrepresented in previous research.
"We retrospectively studied 101 symptomatic angina patients of South Asian origin -- India, Pakistan, Sri Lanka, Nepal, and Bangladesh -- who underwent CT coronary angiography between December 2009 and April 2011 and compared them with 101 consecutive symptomatic Caucasians matched for age, gender, and CAD risk factors," he explained. "Imaging was performed using a 640-slice, 320-row CT scanner with 0.5-mm detector elements, 350 msec of gantry rotation time, and up to 16 cm of coverage in the Z direction."
No significant differences were found between the two groups in age, CAD risk factors, and CAC prevalence. The left anterior descending artery was the predominantly affected artery, with plaques causing more than 25% of obstruction in both groups.
Compared with Caucasians, South Asians had a higher mean CAC score (156 ± 27.4 versus 25.4 ± 6.2), higher mean number of affected coronary artery segments (1.9 ± 2.3 versus. 1.0 ± 1.6), higher incidence of three-vessel disease (25.7% for South Asians, 5.9% for Caucasians), and higher incidence of obstructive CAD (19.8% for South Asians, 5.76% for Caucasians).
In the 37 patients age 50 or younger, the researchers found no significant differences between the two groups in mean CAC score, number of affected segments, and CAD severity and extent. In those older than 50, South Asians had a higher mean CAC score (226 versus 35.9), number of affected segments, and a greater incidence of obstructive CAD (37.5% versus 9.4%), as well as three-vessel disease (37.5% for South Asians, 9.4% for Caucasians). Single-vessel disease was far more common in Caucasians (15.6% for South Asians, 39% for Caucasians).
"This difference [in coronary artery calcification] is age-related, despite similar conventional cardiovascular risk factors," Koulaouzidis concluded. "Our cohort included only patients with stable CAD; therefore, findings should not be extrapolated to patients with acute coronary syndrome."
For further details about this study, go to the International Journal of Cardiology (15 June 2012, Epub ahead of print).
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnieeurope.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&fit=crop&h=100&q=70&w=100)
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnieeurope.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
