ABSTRACT
Coronary artery calcium (CAC) provides predictive information for risk of coronary heart disease (CHD) events
beyond that gained from traditional cardiovascular disease (CVD) risk factors. Hispanics/Latinos have lower
prevalence of CAC than whites, even after accounting for differences in CVD risk factors. They also have lower
rates of CVD mortality and longer life expectancies despite higher rates of risk factors and adverse
socioeconomic conditions (the ‘Hispanic Paradox’), lending credence to the existence of Hispanic/Latino-specific
CVD protective mechanisms. Little data currently exist on the presence/absence and extent of CAC and CT-
derived plaque volume, density, and distribution in diverse Hispanics/Latinos, and their associations with
sociocultural characteristics and lifestyle factors that have been associated with CVD in the Hispanic Community
Health Study/ Study of Latinos (HCHS/SOL) and other cohorts. Another critical knowledge gap is whether
epigenetic mechanisms, i.e., DNA methylation, alone or in conjunction with genetic factors, act as an important
biological link between such risk or protective factors and subclinical/clinical CVD in Hispanics/Latinos. The
proposed study aims to generate critical data on subclinical coronary atherosclerosis (CAC and CT-derived
plaque volume, density, and distribution) for Hispanic/Latino adults from all major heritage groups in the US
(Mexican, Puerto Rican, Cuban, Dominican, and Central/South American) and examine relationships with
sociocultural factors, lifestyle factors, traditional CVD risk factors, and epigenomic patterns. This study will be
conducted ancillary to the ongoing HCHS/SOL, which examined 16,415 Hispanic/Latino men and women ages
18-74 years at Visit 1 (2008-2011) from 4 US communities (San Diego, CA; Chicago, IL; Bronx, NY; and Miami,
FL) and 11,623 participants (81.4% follow-up rate) at Visit 2 (2014-2017). The proposed study will capitalize on
available HCHS/SOL data and will assess CAC absence/presence and features in conjunction with ongoing
HCHS/SOL Visit 3 (2020-2023) in 4,109 participants ages >45 years (mean age 60.5 years, an optimal time
window for CAC detection) and free of known history of CVD. Longitudinal examination of epigenetic biomarkers
will be conducted using stored blood DNA samples from HCHS/SOL Visits 1 and 2 for a subset of participants
(50% of participants who undergo scanning, n=2,054). The proposed study will address critical knowledge gaps
in a highly cost-effective manner by capitalizing on the established HCHS/SOL infrastructure. Examination of
these factors in this heterogeneous, well-characterized cohort, has the potential to generate novel and insightful
epidemiological, etiologic, and mechanistic information beyond that gained from previous studies, which can
help to identify novel preventive targets and inform development of precision prevention/treatment strategies that
may benefit all racial/ethnic groups.
