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Black-white differences in subclinical cardiovascular disease among older adults: the Cardiovascular Health Study.
T A Manolio1, G L Burke, B M Psaty
1Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, MD 20892, USA.
Insights
Black older adults exhibit higher cardiovascular disease (CVD) prevalence and risk factors than white adults. These disparities persist even after accounting for traditional CVD risk factors, indicating unique underlying mechanisms.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Health Disparities
Background:
- Higher mortality from cardiovascular disease (CVD) and all causes is observed in Black Americans compared to White Americans.
- Existing research on racial differences in CVD has primarily focused on younger populations, leaving a gap in understanding for older adults.
Purpose of the Study:
- To compare clinical and subclinical cardiovascular disease (CVD) and associated risk factors between Black and White older adults aged 65 and above.
- To investigate whether traditional CVD risk factors explain observed racial differences in cardiovascular health in this age group.
Main Methods:
- A comparative analysis was conducted on 4926 White and 244 Black men and women aged 65 years and older.
- Evaluated clinical and subclinical CVD indicators, including carotid artery wall thickness and ankle-arm blood pressure ratios.
- Assessed traditional CVD risk factors such as socioeconomic status and lipid profiles.
Main Results:
- Black participants generally had lower socioeconomic status and higher prevalences of CVD and its risk factors, excluding lipid profiles.
- Common carotid artery wall thickness was greater in Black women compared to White women.
- Ankle-arm blood pressure ratios were lower in both Black men and women, and common carotid walls remained thicker in Black individuals after risk factor adjustment.
Conclusions:
- Racial disparities in clinical and subclinical cardiovascular disease (CVD) observed in older adults mirror those in younger populations.
- These differences are not fully explained by conventional CVD risk factors, suggesting potential unique biological or environmental influences in older Black adults.
Abstract:
Cardiovascular and all-cause mortality are higher in black than white Americans, but racial differences in clinical and subclinical cardiovascular disease (CVD) have not been examined in older adults. Clinical and subclinical CVD and its risk factors were compared in 4926 white and 244 black men and women aged 65 years and older. Black participants had lower socioeconomic status and generally higher prevalences of CVD and its risk factors, except for adverse lipid profiles. Common carotid wall thickness was greater in black than white women, and ankle-arm blood pressure ratios were lower in black women and men (p < 0.01). After adjustment for CVD risk factors, common carotid walls were significantly thicker and ankle-arm ratios were lower in blacks than whites of both sexes, while internal carotid walls were significantly thinner in black women. Racial differences in clinical and subclinical CVD in older adults are similar to those reported in younger populations and do not appear to be explained by CVD risk factors.