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Association of Race With Risk of Incident Cardiovascular Disease, Coronary Heart Disease, Heart Failure, and Stroke
Michael J Domanski1, Colin O Wu2, Xin Tian2
1Division of Cardiovascular Medicine and Data Science Initiative, University of Maryland School of Medicine and the VA Medical Center, Baltimore, Maryland, USA.
Insights
Race is an independent risk factor for cardiovascular disease (CVD), stroke, and congestive heart failure (CHF), particularly in Black men and women. These findings highlight disparities in CVD risk impacting different racial groups.
Area of Science:
- Cardiovascular epidemiology
- Health disparities research
- Clinical risk factor analysis
Background:
- Previous studies indicated self-identified race as a risk factor for cardiovascular disease (CVD).
- Recent research suggests clinical, demographic, and socioeconomic factors may explain observed racial differences in CVD risk.
- This study aimed to investigate race as an independent risk factor for incident CVD using propensity score matching.
Purpose of the Study:
- To determine if race independently predicts incident cardiovascular disease (CVD).
- To assess the association between race and specific CVD components like stroke and congestive heart failure (CHF).
Main Methods:
- Analysis of data from the Coronary Artery Risk Development in Young Adults (CARDIA) study.
- Utilized propensity score matching to compare White and Black men, and White and Black women, controlling for known CVD risk factors.
- Employed multivariable analyses to examine the independent associations of race with CVD events.
Main Results:
- Black men exhibited significantly higher risks for CVD, stroke, and congestive heart failure (CHF) compared to White men.
- Black women also showed increased risks for CVD and stroke, with a borderline significant increase for CHF, compared to White women.
- No significant racial differences in coronary heart disease risk were observed for either sex, but multivariable analyses revealed racial disparities in how risk factors influence CVD events.
Conclusions:
- Propensity score matching confirms race as an independent risk factor for incident CVD, CHF, and stroke.
- Multivariable analyses suggest that differing impacts of risk factors between Black and White individuals contribute to these racial disparities.
- Further research is needed to explore the underlying reasons for these observed racial differences in CVD risk factor impact.
Background:
In prior studies of cumulative risk factor exposure, self-identified race was independently associated with incident cardiovascular disease (CVD). A recent study suggests clinical, demographic, and socioeconomic factors explain racial differences. We used propensity score matching to study race as an independent incident CVD risk factor.
Objectives:
The purpose of this study was to assess race as an independent risk factor for incident CVD.
Methods:
We analyzed CARDIA (Coronary Artery Risk Development in Young Adults) study data using propensity score matching of White and Black women, and, separately, White and Black men, with respect to known CVD risk factors.
Results:
Black men (n = 487), compared to White men (n = 487), had higher risk of CVD (HR: 2.30; 95% CI: 1.36-3.89; P = 0.0014), stroke (HR: 5.00; 95% CI: 1.45-17.3; P = 0.0047), and congestive heart failure (CHF) (HR: 3.60; 95% CI: 1.34-9.70; P = 0.0067). Black women (n = 640), compared to White women (n = 640), had higher CVD risk (HR: 2.36; 95% CI: 1.17-4.78; P = 0.014) and stroke risk (HR: 2.80; 95% CI: 1.01-7.77; P = 0.039) and borderline significantly higher CHF risk (HR: 3.50; 95% CI: 0.73-16.9; P = 0.096). Risk of coronary heart disease did not differ significantly by race in either sex. Multivariable analyses showed racial differences in the associations of multiple risk factors with incident CVD events independent of other known CVD risk factors.
Conclusions:
Propensity score matching analyses demonstrate that race is an independent risk factor for incident CVD and its components, CHF, and stroke. Multivariable analyses suggest racial differences in Black vs White risk factor impact as the possible cause. Reasons for these differences remain to be explored.
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