Microvascular vasoregulatory dysfunction in African Americans - An enhanced opportunity for early prevention and...

Area of Science:

• Cardiovascular Health
• Health Disparities
• Vascular Biology

Background:

• Atherosclerotic cardiovascular disease (ASCVD) and its risk factors contribute significantly to cardiovascular health disparities.
• African Americans experience disproportionately higher rates of ASCVD morbidity and mortality.
• Vascular endothelial dysfunction, particularly coronary microvascular dysfunction, is implicated as a key factor.

Purpose of the Study:

• To review evidence linking vascular endothelial dysfunction to excess ASCVD morbidity and mortality in African Americans.
• To explore the role of insulin-resistant cardiometabolic factors in cardiovascular health.
• To discuss mechanistic-based therapeutic strategies for early prevention and personalized treatment.

Main Methods:

• Review of reported evidence on vascular endothelial dysfunction and its impact.
• Analysis of advanced imaging insights into patho-mechanisms.
• Integration of population data (e.g., Jackson Heart Study) and clinical trial/registry findings.

Main Results:

• Vascular endothelial dysfunction is a significant contributor to cardiovascular disparities in African Americans.
• Insulin-resistant cardiometabolic underpinnings are central to the American Heart Association's Life's Essential Eight construct.
• Layered or personalized therapeutic strategies can interrupt disease progression.

Conclusions:

• Coronary microvascular dysfunction plays a critical role in cardiovascular health disparities.
• A unified physiological framework focusing on cardiometabolic health enables early prevention.
• Mechanistic-based, personalized treatments are essential for managing ASCVD risk and improving outcomes.