Role of Race and Ethnicity in Cardiovascular Health

Of the many factors that influence cardiovascular (CV) health, race and ethnicity may play substantial roles.

For example, 47.7% of non-Hispanic black women and 46% of non-Hispanic black men have some form of cardiovascular disease (CVD).¹

“Cardiovascular outcomes vary greatly by racial and ethnic groups in this country. Some have better outcomes than the general population, while others have poorer outcomes,” said Karol E. Watson, MD, PhD, a professor of medicine/cardiology at the David Geffen School of Medicine at the University of California, Los Angeles, and codirector of the University of California, Los Angeles, program in preventive cardiology, when she spoke with Cardiology Advisor.

“While some of these disparities can be explained by lower socioeconomic status, they persist even when you control for education, income, and access,” Dr Watson said.

There are well-established health disparities by race and ethnicity across the American Heart Association’s (AHA) Life’s Simple 7 (LS7) factors that contribute to ideal CV health. The list is part of the AHA’s  2020 Impact Goal of improving CV health in the United States while reducing mortality from CVD and stroke.² Steps include losing or maintaining a healthy weight, quitting smoking, increasing physical activity, eating a healthy diet, and managing blood pressure, cholesterol, and blood glucose.²

“The reasons for the disparities are not fully known and are likely complex and multi-factorial, including genomics, sociocultural, environmental, and treatment-disparity related factors,” Erin D. Michos, MD, MHS, an associate professor of medicine and epidemiology, and associate director of preventive cardiology at Johns Hopkins School of Medicine, Baltimore, Maryland, explained in an interview with Cardiology Advisor. Dr Michos pointed to the following examples of such gaps pertaining to the  items:

• Compared with other racial and ethnic groups in the United States, blacks have higher blood pressure levels and rates of hypertension, which in turn are associated with higher rates of stroke, heart failure, and end-stage renal disease.³
• Native Americans, Hispanics, and blacks have disproportionately higher rates of diabetes than on-Hispanic whites.¹
• Non-Hispanic blacks and Mexican-American women have higher rates of obesity, which is a strong risk factor for diabetes.¹
• Approximately 30% of US adults do not engage in leisure time physical activity, and Hispanic and Non-Hispanic black adults were more likely to be inactive compared with white adults.¹

These statistics are consistent with the results of a recent study published in the Journal of the American Heart Association.⁴ Researchers from numerous US universities analyzed data from the Multi-Ethnic Study of Atherosclerosis (MESA) and found a significantly greater likelihood of low to moderate CV health scores in blacks and Hispanics compared with white and Chinese participants. However, there were no differences between groups in terms of the graded inverse association observed between CV health score and CVD and events.⁴

These findings match those of previous studies, including the northern Manhattan study (NOMAS), with the exception of the “Hispanic paradox” those investigators found: Although Caribbean Hispanics had lower measures of CV health, they had a slightly lower risk for CV events vs whites and blacks.⁵

Tamar Polonsky, MD, a cardiologist and assistant professor of medicine at University of Chicago Medicine in Illinois, and lead author of the recent MESA analysis, told Cardiology Advisor she does not believe there has been sufficient research on this phenomenon to affect clinical practice, as “there are many things that could be affecting the results that aren’t measured, such as genetics, acculturation, social support,” and more.