Ethnic Differences in Cardiovascular Disease Risk Factors: A Systematic Review of North American Evidence

Gasevic, Danijela; Ross, Emily S; Lear, Scott A.

doi:10.1016/j.cjca.2015.06.017

Cited by 60 publications

(51 citation statements)

References 126 publications

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“…Similarly, our study found that non-Hispanic Asians had similar levels of hypertension as non-Hispanic whites and Mexican-Americans among those with and without diabetes. However, our study also found that non-Hispanic Asians were generally less likely to have hypertension than non-Hispanic blacks, which is consistent with previous studies that found non-Hispanic blacks are more likely to have hypertension than other race/ethnicities [12]. …”

Section: Discussionsupporting

confidence: 92%

Cardiometabolic health in Asians with diabetes in the US

Menke

Cowie

2017

Diabetes Research and Clinical Practice

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Aims Asians develop diabetes at lower levels of adiposity than people of other race/ethnicities. However, there is limited data investigating the health of US Asians with diabetes. We compared cardiovascular risk factors in US Asians to other race/ethnicities stratified by diabetes status. Methods Among 4,645 adults in the 2011–2014 National Health and Nutrition Examination Survey (NHANES), a cross-sectional survey of the US population, odds ratios were calculated for obesity, hypertension, and elevated low-density lipoprotein (LDL) cholesterol associated with race/ethnicity after adjustment for age, sex, income, education, smoking, alcohol consumption, and health insurance. Results Overall and stratified by diabetes status, non-Hispanic whites, non-Hispanic blacks, and Mexican-Americans were significantly more likely to be obese compared to non-Hispanic Asians after adjustment. Overall and stratified by diabetes status, adjusted levels of hypertension compared to non-Hispanic Asians was generally similar for non-Hispanic whites and Mexican-Americans and generally more common among non-Hispanic blacks; among those with diagnosed diabetes, the adjusted odds ratios (95% confidence interval) were 1.48 (0.79–2.77), 2.54 (1.49–4.30), and 1.38 (0.73–2.60) for non-Hispanic whites, non-Hispanic blacks, and Mexican-Americans, respectively. Overall and stratified by diabetes status, elevated LDL cholesterol levels were generally similar between non-Hispanic Asians and other race/ethnicities; among those with diagnosed diabetes, the adjusted odds ratios (95% confidence interval) were 0.88 (0.32–2.43), 0.58 (0.24–1.42), and 1.15 (0.29–4.58) for non-Hispanic whites, non-Hispanic blacks, and Mexican-Americans, respectively. Conclusions Although non-Hispanic Asians had lower levels of adiposity compared to other race/ethnicities with diabetes, their adjusted levels of hypertension and LDL cholesterol were generally more comparable.

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Section: Discussionsupporting

confidence: 92%

Cardiometabolic health in Asians with diabetes in the US

Menke

Cowie

2017

Diabetes Research and Clinical Practice

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“…Ethnic differences in prevalence of CVD risk factors are well established,16, 17, 18 which, in turn, partially explain the observed differences in burden of CVD 19, 20. Ethnic differences in the relationship between risk factors and CVD explain why the risk scores developed in whites have performed inconsistently across ethnic groups21 and also why being overweight is associated with greater mortality risk in Asians compared with whites 22.…”

Section: Discussionmentioning

confidence: 99%

Association of “Elevated Blood Pressure” and “Stage 1 Hypertension” With Cardiovascular Mortality Among an Asian Population

Talaei

Hosseini

Koh

et al. 2018

JAHA

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BackgroundThe new American College of Cardiology/American Heart Association high blood pressure (BP) guidelines in the United States have lowered definition of hypertension by defining normal as systolic/diastolic BP <120/80 mm Hg; elevated BP as systolic between 120 and 129 mm Hg and diastolic <80 mm Hg; and stage 1 hypertension as systolic between 130 and 139 mm Hg or diastolic between 80 and 89 mm Hg.Methods and ResultsWe investigated the association between the new hypertension definition and cardiovascular disease mortality among Chinese in Singapore. We used data from 30 636 participants of a population‐based cohort, the SCHS (Singapore Chinese Health Study), who had BPs measured using a standard protocol at ages 46 to 85 years between 1994 and 2005. Information on lifestyle factors was collected at recruitment (1993–1998) and follow‐up 1 interviews (1999 and 2004). Mortality was identified via nationwide registry linkage up to December 31, 2016. Neither elevated BP (hazard ratio, 0.89; 95% confidence interval, 0.74–1.07) nor stage 1 hypertension (hazard ratio, 0.94; 95% confidence interval, 0.81–1.11) was associated with increased risk of cardiovascular mortality compared with normal BP in the whole cohort. Stage 1 hypertension was associated with increased cardiovascular risk only in those <65 years of age and without a history of cardiovascular disease (hazard ratio, 1.40; 95% confidence interval, 1.01–1.94), but not in those ≥65 years of age or with a history of cardiovascular disease.ConclusionsOur data suggest that the newly defined stage 1 hypertension may not be associated with increased cardiovascular mortality across all ages among Chinese in Singapore, but that the at‐risk subpopulation is limited to those <65 years of age and without a prior cardiovascular disease.

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“…Increases in abdominal obesity in women as they transition through menopause are evident in several studies . This increase in CV risk is more pronounced in African American women . Since the adipocyte is now appreciated as a “metabolically active cell” producing adipokines that stimulate hormonal changes, the increase in CV event rates may lie with how the adipocyte functions in the postmenopausal period …”

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confidence: 99%

“…7,8 This increase in CV risk is more pronounced in African American women. [9][10][11] Since the adipocyte is now appreciated as a "metabolically active cell" producing adipokines that stimulate hormonal changes, the increase in CV event rates may lie with how the adipocyte functions in the postmenopausal period. 12,13 One recent advance in our understanding of how abdominal obesity and hypertension are linked is the observation that aldosterone levels are correlated with the magnitude of central adiposity.…”

mentioning

confidence: 99%

Relationship Between Obesity, Hypertension, and Aldosterone Production in Postmenopausal African American Women: A Pilot Study

Laffin

Majewski

Liao

et al. 2016

J of Clinical Hypertension

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2Increased abdominal obesity is associated with increased cardiovascular risk, especially in African American women. The adipocyte is documented to produce a number of inflammatory factors including the hormone aldosterone. There are very few data documenting aldosterone production from adipocytes of postmenopausal women as well as data demonstrating the effects of angiotensin receptor blockade (ARB) on its production in predominately African American women. The authors hypothesize that increased central adipocyte mass in obese postmenopausal women contributes to increased production of aldosterone that is suppressed with the ARB azilsartan medoxomil. The authors tested this hypothesis in a double-blind, placebo-controlled pilot study of 34 hypertensive postmenopausal women (mean age 57.5AE7.5 years), 91% of whom were African American. Patients had a mean 24-hour ambulatory systolic blood pressure of 127AE13 mm Hg off any blocker of the reninangiotensin system but while taking other antihypertensive medications. The authors further validated aldosterone production in a nested cohort of women using fat cells from a fat pad biopsy. Azilsartan reduced 24-hour urinary aldosterone by 47.3% from baseline (P=.03), with between-groups differences in urine aldosterone of À5.3AE52.3% placebo vs À47.3AE32.9% azilsartan (P=.07) at 6 months. An adrenal cell line treated with adipocyte-conditioned media from subcutaneous abdominal adipocytes of postmenopausal women (n=3) showed an increase in aldosterone production blocked by an ARB (1948AE1297 pg/mL fat alone vs 894AE438 pg/mL fat + ARB; P=.022). The authors conclude that aldosterone is produced from subcutaneous adipocytes of obese postmenopausal women. Moreover, use of an ARB significantly reduces aldosterone production within 6 months of use in these women as well as in cells exposed to their adipocytes.

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Ethnic Differences in Cardiovascular Disease Risk Factors: A Systematic Review of North American Evidence

Cited by 60 publications

References 126 publications

Cardiometabolic health in Asians with diabetes in the US

Cardiometabolic health in Asians with diabetes in the US

Association of “Elevated Blood Pressure” and “Stage 1 Hypertension” With Cardiovascular Mortality Among an Asian Population

Relationship Between Obesity, Hypertension, and Aldosterone Production in Postmenopausal African American Women: A Pilot Study

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