Abstract
BackgroundCardiovascular disease (CVD) mortality varies across racial and ethnic groups in the U.S., and the extent that known risk factors can explain the differences has not been extensively explored.MethodsWe examined the risk of dying from acute myocardial infarction (AMI) and other heart disease (OHD) among 139,406 African-American (AA), Native Hawaiian (NH), Japanese-American (JA), Latino and White men and women initially free from cardiovascular disease followed prospectively between 1993–1996 and 2003 in the Multiethnic Cohort Study (MEC). During this period, 946 deaths from AMI and 2,323 deaths from OHD were observed. Relative risks of AMI and OHD mortality were calculated accounting for established CVD risk factors: body mass index (BMI), hypertension, diabetes, smoking, alcohol consumption, amount of vigorous physical activity, educational level, diet and, for women, type and age at menopause and hormone replacement therapy (HRT) use.ResultsEstablished CVD risk factors explained much of the observed racial and ethnic differences in risk of AMI and OHD mortality. After adjustment, NH men and women had greater risks of OHD than Whites (69% excess, P<0.001 and 62% excess, P = 0.003, respectively), and AA women had greater risks of AMI (48% excess, P = 0.01) and OHD (35% excess, P = 0.007). JA men had lower risks of AMI (51% deficit, P<0.001) and OHD (27% deficit, P = 0.001), as did JA women (AMI, 37% deficit, P = 0.03; OHD, 40% deficit, P = 0.001). Latinos had underlying lower risk of AMI death (26% deficit in men and 35% in women, P = 0.03).ConclusionKnown risk factors explain the majority of racial and ethnic differences in mortality due to AMI and OHD. The unexplained excess in NH and AA and the deficits in JA suggest the presence of unmeasured determinants for cardiovascular mortality that are distributed unequally across these populations.
Highlights
Cardiovascular disease (CVD), which we define here to exclude stroke, continues to be one of the most common causes of mortality worldwide, and, in the U.S, it accounts for more than a quarter of all deaths. [1,2,3,4] The patterns of cardiovascular mortality in individual ‘‘racial’’ groups have been examined and the roles of various risk factors defined
Even after controlling for the established risk factors of blood pressure, serum cholesterol, cigarette smoking, and diabetes, African Americans continued to exhibit higher mortality rates from cardiovascular causes when compared to their Caucasian counterparts. [9,10,11,12,13,14] Native Hawaiians have increased rates of obesity, a higher prevalence of diabetes, higher serum cholesterol and the highest cardiovascular mortality rate of any group in Hawaii. [15,16,17] The overall age- and gender-specific mortality rates due to heart disease are 66% greater in Native Hawaiians than Caucasians in the state. [18]
Using the Multiethnic Cohort (MEC), a large population-based study of adult men and women living in Hawaii and California aged 45–75 at recruitment, we have examined the mortality rates from cardiovascular causes in five racial groups, African Americans (AA), Native Hawaiians (NH), Japanese Americans (JA), Latinos (LA) and Whites (W), to address whether the observed differences in CVD mortality can be explained by differences in the prevalence of established CVD risk factors
Summary
Cardiovascular disease (CVD), which we define here to exclude stroke, continues to be one of the most common causes of mortality worldwide, and, in the U.S, it accounts for more than a quarter of all deaths. [1,2,3,4] The patterns of cardiovascular mortality in individual ‘‘racial’’ groups have been examined and the roles of various risk factors defined. Using the Multiethnic Cohort (MEC), a large population-based study of adult men and women living in Hawaii and California aged 45–75 at recruitment, we have examined the mortality rates from cardiovascular causes in five racial groups, African Americans (AA), Native Hawaiians (NH), Japanese Americans (JA), Latinos (LA) and Whites (W), to address whether the observed differences in CVD mortality can be explained by differences in the prevalence of established CVD risk factors. We examined the risk of dying from acute myocardial infarction (AMI) and other heart disease (OHD) among 139,406 African-American (AA), Native Hawaiian (NH), Japanese-American (JA), Latino and White men and women initially free from cardiovascular disease followed prospectively between 1993–1996 and 2003 in the Multiethnic Cohort Study (MEC) During this period, 946 deaths from AMI and 2,323 deaths from OHD were observed. The unexplained excess in NH and AA and the deficits in JA suggest the presence of unmeasured determinants for cardiovascular mortality that are distributed unequally across these populations
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
