Background
Computed tomography (CT) coronary artery calcium (CAC) scoring has been shown to predict major adverse cardiovascular events (MACE) in adults. Despite the burden of coronary artery disease in Indigenous Peoples globally, validity of CT CAC scoring in this population has been poorly described.
Methods
A systematic search was conducted on MEDLINE, EMBASE, CINAHL, Scopus and Web of Science databases from 1990 to 2022. Primary observational studies that reported CT CAC scores and Indigenous ethnicity were included. The primary outcome was the prevalence of a CT CAC score>0. The secondary outcome was MACE.
Results
Eight studies on CT CAC scoring stratified results according to Indigenous ethnicity (n=30,845 and 1,677 Indigenous). Prevalence of CT CAC score>0 was higher in Australian First Nations people than non-Indigenous people [adjusted odds ratios (aOR) 2.36, 95% confidence interval (CI) 1.32–4.23; p=0.004 and aOR 2.76, 95% CI 1.30–5.87; p=0.008] but not in Native Americans (aOR 0.70, 95% CI 0.42-1.18) or Indigenous Brazilians (aOR 0.96, 95% CI 0.30 – 3.11). Two studies assessed the interaction of Indigenous ethnicity on the association between CAC>0 and MACE. Neither found a significant interaction (p=0.64 and 0.53).
Conclusion
From 2,431 studies, eight reported CT CAC scores stratified by Indigenous ethnicity. From limited data, prevalence of CT CAC score>0 was higher in Australian First Nations people compared to non-Indigenous Australians and CT CAC score>0 was similarly able to predict MACE in Indigenous Peoples. Future research on CT CAC scoring should stratify outcomes according to Indigenous status to better understand its utility.