Heart Disease in Racially and Ethnically Diverse Populations

Cardiovascular Disease in Racial and Ethnic Groups

According to the 2017 National Center for Health Statistics (NHIS), the burden of coronary heart diseases (CHDs) varies by racial or ethnic group. Although death rates from heart disease are declining for all race/ethnic groups, the rate of decline has been slower for race-ethnic minorities. In 2000, the age-adjusted death rate for heart disease was 326.5 per 100,000 people among non-Hispanic (NH) Blacks compared with 253.6 deaths per 100,000 among NH whites. In 2017, the age-adjusted death rate had declined to 208.0 per 100,000 people among NH Blacks compared with 168.9 deaths per 100,000 among NH whites, thus preserving the higher rate of death for Blacks observed in 2000. For Blacks and whites in the Atherosclerosis Risk In Communities (ARIC), Cardiovascular Health Study (CHS), and Reasons for Geographic And Racial Differences in Stroke (REGARDS) study, Black men were twice as likely to experience fatal CHD as white men (age-adjusted hazard ratio [HR], 2.09; 95% confidence interval [CI], 1.42 to 3.06), and Black women were more than twice as likely experience fatal CHD than white women (HR, 2.61; 95% CI, 1.57 to 4.34). These differences in fatal CHD were largely attributable to social determinants of health and cardiovascular risk factors. Disparities in stroke prevalence and incidence are even greater.

Hypertension (see also Chapter 26 )

Blacks have higher rates of hypertension than other racial or ethnic groups. Several proposed mechanisms may contribute to an increased incidence in Blacks ( Fig. 93.1 ). Figure 93.2 presents the epidemiology of hypertension awareness, treatment, and control (see Fig. 93.3A-C ) in the United States. Although rates of awareness in Blacks are higher (see Fig. 93.3A ) than in other groups, and Blacks are more likely to be on treatment (see Fig. 93.3B ) and use more medications to treat hypertension, Blacks have a lower rate of control than other racial or ethnic groups (see Fig. 93.3C ). American Indian/Alaska Natives (27.2%) also have higher rates of hypertension than Native Hawaiian or Other Pacific Islander (PI) (24.0%), Hispanic or LatinX (23.7%), white (24.8%), or Asian adults (21.9%).

Among Hispanics/LatinXs, the hypertension prevalence varies considerably by subgroup. In the Hispanic Community Health Study/Study of LatinXs (HCHS/SOL), which measured blood pressure in 16,415 Hispanics/LatinXs (but does not include a comparison population of NHs), rates were highest among participants from Cuban, Puerto Rican, and Dominican ethnic backgrounds. Hispanics/LatinXs are less likely to be aware of their hypertension and less likely to be treated than NH whites. ^,

National estimates of hypertension prevalence based on measured blood pressure in Asian Americans are lacking. Amongst the six largest Asian American populations (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese), Filipinos have particularly high rates of hypertension (53.2% to 59.9%), with poor awareness and control rates. Filipino patients of older age, those with comorbid medical conditions, and those who did not smoke had improved hypertension treatment, and patients with health insurance had better blood pressure control. These findings suggest that better access to health care and an approach targeted toward multiple risk factors are needed to decrease the hypertension prevalence and risk among Filipinos.