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African-Americans have the highest rate of coronary disease mortality, premature death (including sudden death), stroke (fatal and non-fatal), hypertension, type 2 diabetes, and obesity (especially black females) when compared to whites. Cardiovascular health, life-expectancy, and health care, while improving dramatically for all Americans over the last century, have not been distributed equitably...
Cardiovascular epidemiology plays a fundamental role in the assessment of disease burden and evaluation of health disparities. Although current epidemiologic data have important limitations, they nevertheless provide compelling evidence that racial and ethnic disparities in cardiovascular health are pervasive and that they contribute to a lower life expectancy, excess morbidity, and reduced quality...
The cardiovascular disease (CVD) burden and disparities within the general population are largely determined by environmental, dietary, and other lifestyle factors. Minority groups have higher rates of morbidity and mortality than do their white counterparts for many diseases, including CVD. Overall, social and environmental factors seem to be more explanatory and influential than genetic factors...
Race is an enigma, exhibiting no clear biological definition yet strong cultural and social meanings, particularly in the United States. However, the advent of molecular technology led to a new realization that within-group differences far exceeded between-group differences. Our knowledge of human genetic variation has grown enormously over the past few decades. Single-nucleotide polymorphisms (SNPs)...
Significant strides from personalized medicine hold great promise to improve early detection, guide targeted therapies, and enhance disease monitoring while simultaneously incorporating specific contributions from race and ethnicity in disease pathogenesis. Hypertension underscores complex gene–environment interactions related to salt sensitivity. Genetic disorders in which certain candidate genes...
The impact of hypertension is a major contributor to the largely uncontrolled, global disease burden across all racial/ethnic groups. African-Americans have a higher incidence and prevalence of hypertension compared with Caucasians. End-organ manifestations continue to be multi-factorial and have been closely associated with salt sensitivity, obesity, and overactivity of the sympathetic nervous system...
Some population groups in the United States have excess burdens of major risk factors for cardiovascular disease (CVD) and are more likely to have more risk factors than their white counterparts. Although the reasons for the excess CVD mortality among African-Americans remain controversial, it is evident that the high prevalence and suboptimal control of coronary risk factors and a greater degree...
Over the last decade, the increased research focus on cardiovascular imaging for the identification of patients at risk for and with significant coronary artery disease (CAD) has augmented clinician awareness and ability to properly risk stratify and categorize patients. Cardiac imaging has now become a technique not only for assessing patients with established CAD but also for the identification...
This chapter will review the epidemiology of overweight and obesity, summarize the relationship of weight with blood pressure (BP), examine the effectiveness of lifestyle intervention trials in achieving weight loss, review differences in weight loss success by racial/ethnic groups, and explore factors that might explain observed differences in racial/ethnic responses to lifestyle interventions. Worldwide,...
The prevalence of the cardiometabolic syndrome (CMS), a cluster of cardiovascular disease (CVD) risk factors which include central obesity, dysglycemia, atherogenic dyslipidemia, hypertension (hypertension), and microalbuminuria (MAU), has increased. Obesity largely drives the dramatic increase in the incidence and prevalence of the CMS worldwide. Recently there has been increasing interest in the...
Several methods have been suggested to estimate the risk for initial coronary heart disease (CHD) events. Prior to the availability of modern computer methods, there was no easy way to adapt risk estimates to clinical practice. In 1998, the Framingham CHD risk approach was simplified, leading to greater interest in using risk prediction algorithms for clinical care. This formulation used categories...
Over the last decade, the increased research focus on cardiovascular imaging for the identification of patients at risk for and with significant coronary artery disease (CAD) has augmented clinician awareness and ability to properly risk stratify and categorize patients. Cardiac imaging has now become a technique not only for assessing patients with established CAD but also for the identification...
Cardiac ultrasound is a portable, relatively inexpensive primary tool which assists the clinician with evaluation of several conditions found disproportionately in minority populations. Left ventricular hypertrophy (LVH) is more prevalent in African-Americans and this is a precursor to increased cardiovascular morbidity and mortality in this population. Left ventricular systolic and diastolic dysfunction...
Heart failure management continues to excel through evidence-based efforts. In relation to race/ethnicity, heart failure continues to disproportionately affect minorities, often with a significantly different phenotypical profile. As the evidence strengthens for heart failure management, there are rising concerns of differential effects of medical therapies for various minority groups. Even so, there...
Large epidemiological studies have helped define differences in majority and minority population health risks and outcomes. The National Health and Nutrition Examination Survey (NHANES) observed African-American, Mexican American, and white non-Hispanic women from 1988 to 1994 and found a striking prevalence of abdominal obesity and metabolic syndrome in both African-Americans and Mexican Americans...
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