Prevalence and prognostic value of elevated computed tomography coronary artery calcium scores in Indigenous peoples globally: A systematic review.

Despite the significant burden of disease in Indigenous Peoples globally, the validity of computed tomography (CT) coronary artery calcium (CAC) scoring has been poorly described. Thus, we aimed to identify the prevalence and predictive utility of a CT CAC score > 0 in this population. 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. 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). From 2431 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.