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Racial Differences in Heart Age and Impact on Mortality
Joshua R Hirsch1, George Waits2, Yabing Li3
1Wake Forest School of Medicine, Winston Salem, NC, USA.
Insights
Racial disparities exist in cardiovascular health, with Black and Hispanic individuals showing higher excess heart age. However, the risk of cardiovascular death associated with excess heart age is greater in White individuals.
Area of Science:
- Cardiovascular epidemiology
- Health disparities research
- Preventive cardiology
Background:
- Heart age estimates cardiovascular system's age based on risk factors.
- Excess heart age quantifies additional cardiovascular disease (CVD) risk.
Purpose of the Study:
- To investigate racial differences in excess heart age.
- To determine if race modifies the association between excess heart age and CVD mortality.
Main Methods:
- Analysis of 5110 NHANES III participants without CVD.
- Heart age calculated using Framingham risk functions.
- Cox proportional-hazards models assessed excess heart age and CVD mortality risk by race.
Main Results:
- Mean excess heart age was highest in non-Hispanic blacks (13.0 yrs), followed by Mexican-Americans (10.5 yrs) and non-Hispanic whites (8.5 yrs).
- Each 10-year increase in excess heart age correlated with a 65% higher CVD mortality risk.
- The association between excess heart age and CVD mortality was stronger in non-Hispanic whites compared to Black and Mexican-American participants.
Conclusions:
- Non-Hispanic Black and Mexican-American individuals exhibit greater excess heart age than non-Hispanic whites.
- The CVD mortality risk for a given level of excess heart age appears more significant in non-Hispanic whites.
- Further research is needed to guide interventions aimed at reducing ethnic health disparities in cardiovascular disease.
Background:
Heart age is an estimate of the age of a person's cardiovascular system given their cardiovascular disease (CVD) risk factors. The difference between a person's chronological age and heart age (excess heart age) represents their added CVD risk.
Objective:
To examine racial differences in excess heart age and whether race impacts the association between excess heart age and CVD mortality.
Methods:
This analysis included 5110 participants (2449 non-Hispanic white, 1287 non-Hispanic black, and 1374 Mexican-American) from the NHANES III who were free of CVD. Heart age was calculated using the sex-specific non-laboratory-based Framingham risk prediction functions. Multivariable Cox proportional-hazards regression models were used to evaluate the relationship (overall and by race) between excess heart age and CVD mortality.
Results:
Mean excess heart age was greatest in non-Hispanic blacks (13.0 years), followed by Mexican-Americans (10.5 years), and non-Hispanic whites (8.5 years); p < 0.001 for pairwise differences. Over a mean follow-up of 13.0 years, 394 CVD deaths occurred. Each 10 years of excess heart age was associated with 65% increased risk of CVD mortality (HR, 95% CI: 1.65, 1.53-1.78). This association was stronger in non-Hispanic whites (1.83, 1.63-2.02) compared to non-Hispanic blacks (1.50, 1.29-1.72) and Mexican American (1.60, 1.33-1.87), interaction p = 0.065.
Conclusions:
Compared to non-Hispanic whites, non-Hispanic blacks and Mexican Americans have more excess heart age, but the risk of CVD death for the same level of excess heart age appears more pronounced in non-Hispanic whites. Further investigation is needed to show the usefulness of these findings in directing future efforts and resource allocation for reduction of health disparities between ethnic groups.
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