Established Risk Factors Account for Most of the Racial Differences in Cardiovascular Disease Mortality

Abstract

BackgroundCardiovascular disease (CVD) mortality varies across racial and ethnic groups in the U.S., and the extent that known risk factors can explain the differences has not been extensively explored.MethodsWe examined the risk of dying from acute myocardial infarction (AMI) and other heart disease (OHD) among 139,406 African-American (AA), Native Hawaiian (NH), Japanese-American (JA), Latino and White men and women initially free from cardiovascular disease followed prospectively between 1993–1996 and 2003 in the Multiethnic Cohort Study (MEC). During this period, 946 deaths from AMI and 2,323 deaths from OHD were observed. Relative risks of AMI and OHD mortality were calculated accounting for established CVD risk factors: body mass index (BMI), hypertension, diabetes, smoking, alcohol consumption, amount of vigorous physical activity, educational level, diet and, for women, type and age at menopause and hormone replacement therapy (HRT) use.ResultsEstablished CVD risk factors explained much of the observed racial and ethnic differences in risk of AMI and OHD mortality. After adjustment, NH men and women had greater risks of OHD than Whites (69% excess, P<0.001 and 62% excess, P = 0.003, respectively), and AA women had greater risks of AMI (48% excess, P = 0.01) and OHD (35% excess, P = 0.007). JA men had lower risks of AMI (51% deficit, P<0.001) and OHD (27% deficit, P = 0.001), as did JA women (AMI, 37% deficit, P = 0.03; OHD, 40% deficit, P = 0.001). Latinos had underlying lower risk of AMI death (26% deficit in men and 35% in women, P = 0.03).ConclusionKnown risk factors explain the majority of racial and ethnic differences in mortality due to AMI and OHD. The unexplained excess in NH and AA and the deficits in JA suggest the presence of unmeasured determinants for cardiovascular mortality that are distributed unequally across these populations.

Disparities among Asians and Native Hawaiians and Pacific Islanders with ischemic stroke

“…Furthermore, NHPI have a higher prevalence of metabolic syndrome characteristics (diabetes, obesity, and/or lower HDL levels) compared with whites, which is consistent with prior studies. [10][11][12][13][14][15] In our study, NHPI with ischemic stroke were a decade younger than whites, a finding similar to the results of other observational ischemic stroke studies that compared non-Hispanic whites to Maoris from New Zealand, 21 Hispanics, 4,22 and blacks. 4,22 The higher burden of cardiovascular risk factors seen in NHPI is similar to the disparities seen among Hispanics and blacks, [5][6][7]22 and supports the idea that minority racial groups overall have a younger age of stroke onset and higher burden of cardiovascular risk factors compared with whites.…”

“…For example, NHPI in the community have been shown to have higher prevalence of major cardiovascular risk factors [10][11][12][13][14][15] and die at a younger age from various cardiovascular disease-related complications compared with other major racial groups. 16,17 However, the specific disease burden related to ischemic stroke in the NHPI and Asian populations has not been studied.…”

Cardiometabolic Changes and Disparities Among Persons With Spinal Cord Injury: A 17-Year Cohort Study

“…Indeed, the possible clinical importance of this disparity among persons with SCI is emphasized by findings among the able-bodied, where Hispanic people have rates of cardiovascular disease similar to those of Whites. 16 Interpretation of our findings on cardiometabolic changes for women is uncertain, and we propose that a larger study on the progression of cardiometabolic disease in women with SCI is thereby warranted. A progression of cardiometabolic syndrome with aging in women with SCI would be consistent with a report showing that able-bodied women develop atherosclerosis later than do able-bodied men.…”

“…Traditional risk factors explain the majority of the differences in mortality from cardiovascular disease among racial/ethnic groups and between sexes in the United States. 16 The exceptions to this explanation are Black women, Pacific Islanders, and Hispanics. Compared to Whites, Black women and Pacific Islanders have higher mortality from cardiovascular disease than expected from risk factors alone, whereas Hispanics have lower mortality than expected.…”

“…In the able-bodied, disparities associated with race/ethnicity include higher rates of coronary artery disease and/or diabetes among Blacks, Hispanics, and Asians/Pacific Islanders. [15][16][17] Cardiometabolic disparities associated with race/ ethnicity are probably related to nutrition that is linked to culture, which may be influenced by socioeconomic status, and to genetic adaptations coupled with cultural nutritional history. Racial/ ethnic cardiometabolic disparities may also be influenced by restricted access to health care associated with poverty.…”