, Volume 5, Issue 3, pp 200-206
Date: 08 Feb 2011

Dissociation Between Cardiovascular Risk Markers and Clinical Outcomes in African Americans: Need for Greater Mechanistic Insight

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Despite having distinct advantages, such as lower serum triglycerides, higher high-density lipoprotein (HDL) cholesterol levels, and less visceral adiposity, African Americans suffer disproportionately from cardiovascular disease (CVD). In African Americans, attention often focuses on two cardiometabolic risk factors—hypertension and type 2 diabetes mellitus—because they occur more frequently in African Americans than whites. Exactly how hypertension and hyperglycemia appear to override benefits from the lower prevalence of dyslipidemia and other factors is unknown. From a practical viewpoint, as the combined effects of hypertension and type 2 diabetes mellitus are dominant, then primary prevention with vigorous control of these conditions must be of utmost priority. However, because attention is focused on hypertension and type 2 diabetes mellitus, the role of other potential risk factors, such as low-density lipoprotein cholesterol oxidation, HDL cholesterol function, lipoxygenase pathway, endothelial progenitor cells, and natriuretic peptide regulation, have not been well studied. In this review, we discuss the paradox of CVD morbidity and mortality among African Americans and offer suggestions for future investigation.