Diabetes and CVD Risk: Special Considerations in African Americans Related to Care

Abstract

Among patients with type 2 diabetes (T2D), cardiovascular disease (CVD) is the leading cause of death regardless of ethnicity. However, recent studies suggest that special considerations should be taken into account when caring for African Americans with T2D, as risk factors, incidence, prevalence, and mortality differ from other populations. This review highlights literature supporting the unique characteristics of managing cardiovascular risk and mortality in African Americans (AAs) with T2D. African Americans have an increased risk of developing T2D and have a higher prevalence of T2D compared with non-Hispanic whites. Certain cardiovascular risk factors, including hypertension and obesity, are particularly challenging in African Americans with T2D and influence CVD and mortality. Treatment regimens including lifestyle modification, pharmacologic interventions, and surgery to manage T2D in patients of all populations may not produce equitable outcomes in African Americans. Particularly, newer cardiovascular outcome trials for sodium-glucose co-transporter 2 (SGLT2) inhibitors and glucose-like peptide 1 receptor (GLP-1R) agonists have disparate effect estimates for major adverse cardiovascular event reduction in African Americans. Thus, research focused on cardiovascular risk reduction in African Americans is of paramount importance. In summary, there are numerous discrepancies in the outcomes of recent cardiovascular risk trials for the diagnosis, assessment and treatment of African Americans with T2D. Future investigations must lead to improved cardiovascular outcomes through evidence-based care of T2D in African Americans if we are to continue to lower the burden of CVD in the USA.