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Established risk factors account for most of the racial differences in cardiovascular disease mortality

Sean O Henderson1, Christopher A Haiman, Lynne R Wilkens

  • 1Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, United States of America. sohender@hsc.usc.edu

Plos One
|April 19, 2007
PubMed

Insights

Known risk factors explain most racial and ethnic disparities in cardiovascular disease mortality. However, unexplained risks in Native Hawaiian and African American groups, and lower risks in Japanese Americans, suggest unmeasured factors influence heart disease deaths.

Area of Science:

  • Epidemiology
  • Cardiovascular Disease Research
  • Health Disparities

Background:

  • Cardiovascular disease (CVD) mortality rates differ significantly among racial and ethnic groups in the U.S.
  • The degree to which established risk factors account for these disparities remains under-explored.

Purpose of the Study:

  • To investigate how known cardiovascular disease risk factors explain mortality differences from acute myocardial infarction (AMI) and other heart disease (OHD) across diverse racial and ethnic groups.
  • To identify potential unmeasured determinants of cardiovascular mortality.

Main Methods:

  • Prospective cohort study of 139,406 individuals from diverse racial/ethnic backgrounds (African American, Native Hawaiian, Japanese American, Latino, White) free of CVD.
  • Analysis of AMI and OHD mortality over a 10-year period (1993-2003) within the Multiethnic Cohort Study.
  • Calculation of relative risks adjusted for numerous CVD risk factors including BMI, hypertension, diabetes, smoking, alcohol, physical activity, education, diet, and menopausal factors for women.

Main Results:

  • Established risk factors explained a substantial portion of racial/ethnic differences in AMI and OHD mortality.
  • Native Hawaiian men and women showed increased OHD risk (69% and 62% excess, respectively) compared to Whites after adjustment.
  • African American women had higher AMI (48% excess) and OHD (35% excess) risks. Japanese Americans exhibited significantly lower risks for both AMI and OHD.
  • Latino men and women had lower risks of AMI death (26% and 35% deficit, respectively).

Conclusions:

  • The majority of racial and ethnic variations in AMI and OHD mortality are attributable to known risk factors.
  • Unexplained excess mortality in Native Hawaiians and African Americans, and deficits in Japanese Americans, point to unmeasured factors influencing cardiovascular outcomes.
  • These findings highlight the need for further research into population-specific, unmeasured determinants of cardiovascular mortality.
Abstract

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