Quantified coronary plaque characteristics between Caucasian and Morise score-matched South Asian populations


Low-attenuation plaques (LAPs) are associated with an increased risk of cardiovascular mortality and morbidity. South Asians experience poorer cardiovascular outcomes compared to Caucasian populations. We hypothesised that South Asian population has a higher prevalence of LAP compared to Caucasians and this difference predicts major adverse cardiovascular events. 72 Caucasian and 72 Morise score-matched South Asian patients were identified from a cardiac computed tomography angiography (CCTA) registry. Coronary artery plaque subtypes in proximal major epicardial and left main arteries were analysed from CCTA images using pre-determined attenuation ranges in Hounsfield units (HUs): 1 to 30 HU (low attenuation), 31 to 70 HU (intermediate attenuation), 71 to 150 HU (high attenuation), and mean coronary lumen + 2 standard deviations to 1000 HU (calcified). For each analysis, data comparison was performed for plaque volumes after normalising for the corresponding coronary artery outer vessel wall volume. The baseline characteristics and total plaque score of the two cohorts were similar. There were no statistically significant differences in low, intermediate, and high- attenuation, or calcified normalised plaque volumes between Caucasian and Morise score-matched South Asian cohorts. After a mean follow up of 32 months, major adverse cardiovascular events were similar between Caucasians and South Asians. In a Morise score-matched ethnicity study, we found no significant differences in plaque subtypes including LAP in South Asians compared to a Caucasian cohort. Other factors accounting for poor outcomes in South Asians should be investigated.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4


  1. 1.

    Moran AE, Forouzanfar MH, Roth GA, Mensah GA, Ezzati M, Flaxman A et al (2014) The global burden of ischemic heart disease in 1990 and 2010: the Global Burden of Disease 2010 Study. Circulation 129(14):1493–1501

    Article  Google Scholar 

  2. 2.

    Moran AE, Tzong KY, Forouzanfar MH, Rothy GA, Mensah GA, Ezzati M et al (2014) Variations in ischemic heart disease burden by age, country, and income: the Global Burden of Diseases, Injuries, and Risk Factors 2010 Study. Glob Heart 9(1):91–99

    Article  Google Scholar 

  3. 3.

    Harding S, Rosato M, Teyhan A (2008) Trends for coronary heart disease and stroke mortality among migrants in England and Wales, 1979–2003: slow declines notable for some groups. Heart 94(4):463–470

    CAS  Article  Google Scholar 

  4. 4.

    Wilkinson P, Sayer J, Laji K, Grundy C, Marchant B, Kopelman P et al (1996) Comparison of case fatality in south Asian and white patients after acute myocardial infarction: observational study. BMJ 312(7042):1330–1333

    CAS  Article  Google Scholar 

  5. 5.

    Prabhakaran D, Jeemon P, Roy A (2016) Cardiovascular diseases in India. Circulation 133(16):1605–1620

    Article  Google Scholar 

  6. 6.

    Falk E, Shah Prediman K, Fuster V (1995) Coronary plaque disruption. Circulation 92(3):657–671

    CAS  Article  Google Scholar 

  7. 7.

    Stone GW, Maehara A, Lansky AJ, de Bruyne B, Cristea E, Mintz GS et al (2011) A prospective natural-history study of coronary atherosclerosis. N Engl J Med 364(3):226–235

    CAS  Article  Google Scholar 

  8. 8.

    Puchner SB, Liu T, Mayrhofer T, Truong QA, Lee H, Fleg JL et al (2014) High-risk plaque detected on coronary CT angiography predicts acute coronary syndromes independent of significant stenosis in acute chest pain: results from the ROMICAT-II Trial. J Am Coll Cardiol 64(7):684–692

    Article  Google Scholar 

  9. 9.

    Virmani R, Burke AP, Farb A, Kolodgie FD (2006) Pathology of the vulnerable plaque. J Am Coll Cardiol 47(8 Suppl):C13–C18

    CAS  Article  Google Scholar 

  10. 10.

    Motoyama S, Sarai M, Harigaya H, Anno H, Inoue K, Hara T et al (2009) Computed tomographic angiography characteristics of atherosclerotic plaques subsequently resulting in acute coronary syndrome. J Am Coll Cardiol 54(1):49–57

    Article  Google Scholar 

  11. 11.

    Al’Aref SJ, Pena JM, Min JK (2019) High-risk atherosclerotic plaque features for cardiovascular risk assessment in the Prospective Multicenter Imaging Study for Evaluation of Chest Pain Trial. Cardiovasc Diagn Ther 9(1):89–93

    Article  Google Scholar 

  12. 12.

    Williams MC, Moss AJ, Dweck M, Adamson PD, Alam S, Hunter A et al (2019) Coronary artery plaque characteristics associated with adverse outcomes in the SCOT-HEART Study. J Am Coll Cardiol 73(3):291–301

    Article  Google Scholar 

  13. 13.

    Dwivedi G, Liu Y, Tewari S, Inacio J, Pelletier-Galarneau M, Chow BJ (2016) Incremental prognostic value of quantified vulnerable plaque by cardiac computed tomography: a pilot study. J Thorac Imaging 31(6):373–379

    Article  Google Scholar 

  14. 14.

    Shephard DA (1976) The 1975 Declaration of Helsinki and consent. Can Med Assoc J 115(12):1191

    CAS  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Thygesen K, Alpert Joseph S, Jaffe Allan S, Simoons Maarten L, Chaitman Bernard R, White Harvey D (2012) Third universal definition of myocardial infarction. Circulation 126(16):2020–2035

    Article  Google Scholar 

  16. 16.

    Diamond GA, Forrester JS (1979) Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease. N Engl J Med 300(24):1350–1358

    CAS  Article  Google Scholar 

  17. 17.

    Chow BJ, Abraham A, Wells GA, Chen L, Ruddy TD, Yam Y et al (2009) Diagnostic accuracy and impact of computed tomographic coronary angiography on utilization of invasive coronary angiography. Circ Cardiovasc Imaging 2(1):16–23

    Article  Google Scholar 

  18. 18.

    Chow BJ, Wells GA, Chen L, Yam Y, Galiwango P, Abraham A et al (2010) Prognostic value of 64-slice cardiac computed tomography severity of coronary artery disease, coronary atherosclerosis, and left ventricular ejection fraction. J Am Coll Cardiol 55(10):1017–1028

    Article  Google Scholar 

  19. 19.

    Raff GL, Abidov A, Achenbach S, Berman DS, Boxt LM, Budoff MJ et al (2009) SCCT guidelines for the interpretation and reporting of coronary computed tomographic angiography. J Cardiovasc Comput Tomogr 3(2):122–136

    Article  Google Scholar 

  20. 20.

    Gujral UP, Pradeepa R, Weber MB, Narayan KM, Mohan V (2013) Type 2 diabetes in South Asians: similarities and differences with white Caucasian and other populations. Ann NY Acad Sci 1281:51–63

    Article  Google Scholar 

  21. 21.

    Joshi P, Islam S, Pais P, Reddy S, Dorairaj P, Kazmi K et al (2007) Risk factors for early myocardial infarction in South Asians compared with individuals in other countries. JAMA 297(3):286–294

    CAS  Article  Google Scholar 

  22. 22.

    Kanaya Alka M, Schembri M, Dave S, Gupta R, Khurana N, Srivastava S et al (2012) Abstract P158: excess CVD risk factors, CAC and carotid IMT in US South Asians: preliminary results from the MASALA Study. Circulation 125(Suppl_10):AP158-AP158P

    Google Scholar 

  23. 23.

    Morise AP, Haddad WJ, Beckner D (1997) Development and validation of a clinical score to estimate the probability of coronary artery disease in men and women presenting with suspected coronary disease. Am J Med 102(4):350–356

    CAS  Article  Google Scholar 

  24. 24.

    Gupta M, Doobay AV, Singh N, Anand SS, Raja F, Mawji F et al (2002) Risk factors, hospital management and outcomes after acute myocardial infarction in South Asian Canadians and matched control subjects. Can Med Assoc J 166(6):717–722

    Google Scholar 

  25. 25.

    Gijsberts CM, Seneviratna A, Hoefer IE, Agostoni P, Rittersma SZ, Pasterkamp G et al (2015) Inter-ethnic differences in quantified coronary artery disease severity and all-cause mortality among Dutch and Singaporean percutaneous coronary intervention patients. PLoS ONE 10(7):e0131977

    Article  Google Scholar 

  26. 26.

    Jose PO, Frank AT, Kapphahn KI, Goldstein BA, Eggleston K, Hastings KG et al (2014) Cardiovascular disease mortality in Asian Americans. J Am Coll Cardiol 64(23):2486–2494

    Article  Google Scholar 

  27. 27.

    Gupta M, Singh N, Warsi M, Reiter M, Ali K (2001) Canadian South Asians have more severe angiographic coronary disease than European Canadians despite having fewer risk factors. Can J Cardiol 17(Suppl C):226C

    Google Scholar 

  28. 28.

    Hasan RK, Ginwala NT, Shah RY, Kumbhani DJ, Wilensky RL, Mehta NN (2011) Quantitative angiography in South Asians reveals differences in vessel size and coronary artery disease severity compared to Caucasians. Am J Cardiovasc Dis 1(1):31–37

    PubMed  PubMed Central  Google Scholar 

  29. 29.

    Makaryus AN, Dhama B, Raince J, Raince A, Garyali S, Labana SS et al (2005) Coronary artery diameter as a risk factor for acute coronary syndromes in Asian-Indians. Am J Cardiol 96(6):778–780

    Article  Google Scholar 

  30. 30.

    Brister SJ, Hamdulay Z, Verma S, Maganti M, Buchanan MR (2007) Ethnic diversity: South Asian ethnicity is associated with increased coronary artery bypass grafting mortality. J Thorac Cardiovasc Surg 133(1):150–154

    Article  Google Scholar 

  31. 31.

    Adams DB, Narayan O, Munnur RK, Cameron JD, Wong DT, Talman AH et al (2017) Ethnic differences in coronary plaque and epicardial fat volume quantified using computed tomography. Int J Cardiovasc Imaging 33(2):241–249

    Article  Google Scholar 

Download references



Author information



Corresponding author

Correspondence to Benjamin J. Chow.

Ethics declarations

Conflict of interest

BC holds the Saul and Edna Goldfarb Chair in Cardiac Imaging Research. He receives research support from CV Diagnostix and educational support from TeraRecon, Inc. GD was supported by a CIHR New Investigator Salary Support Award while at UOHI. GD has received Speaker Bureau Fees from Amgen and Astra Zeneca not related to this publication. GD advises Artrya Pty Ltd. as consultant.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Gahungu, N., Tewari, S., Liu, Y.W. et al. Quantified coronary plaque characteristics between Caucasian and Morise score-matched South Asian populations. Int J Cardiovasc Imaging 36, 2347–2355 (2020). https://doi.org/10.1007/s10554-020-01802-y

Download citation


  • Coronary plaque characteristics
  • Caucasian
  • Low-attenuation plaques
  • Morise score
  • South Asian