Zhang L, Olalere D, Mayrhofer T, et al. - In this study, Black persons were found to have a greater cardiovascular risk burden than White persons, but the former group exhibited lower rates of coronary artery calcium, stenosis, and high-risk plaque on coronary computed tomography angiography compared with the latter group. This implies that cardiovascular risk burden and coronary plaque differ between Black and White individuals with stable chest pain.

• In this nested observational cohort study within the PROMISE trial, a total of 1,071 non-Hispanic Black (hereafter Black) and 7,693 non-Hispanic White (hereafter White) participants with stable chest pain undergoing noninvasive cardiovascular testing were included.

• The composite of death, myocardial infarction, or hospitalization for unstable angina over a median follow-up of 24.4 months was assessed (primary endpoint).

• A higher cardiovascular risk burden (more hypertension and diabetes) was observed in Black participants, yet a similarly low major adverse cardiovascular events rate was evident over a median 2-year follow-up (32 [3.0%] vs 243 [3.2%]; P = .84).

• In both groups, significant stenosis and high-risk plaque were linked with events; however, Black individuals showed a lower prevalence of a coronary artery calcium score greater than 0, stenosis 50% or greater, and high-risk plaque.