Current Cardiovascular Risk Reports

, Volume 3, Issue 3, pp 187–193

Cardiovascular disease disparities: Racial/ethnic factors and potential solutions



Disparities persist in cardiovascular disease, and it is difficult to separate socioeconomic status from race/ethnicity or genetic factors. Blacks have more hypertension, with higher cardiovascular morbidity and mortality. Despite high rates of type 2 diabetes and obesity, Hispanics do not appear to have higher cardiovascular mortality than non-Hispanic whites or blacks. South Asians have premature coronary heart disease, with more metabolic syndrome and diabetes. Racial/ethnic pharmacogenetics does not justify withholding appropriate medications. However, pharmacogenetics demonstrates the importance of using starting doses of medications that are ethnic specific. The Agency for Healthcare Research and Quality reports that the uninsured have difficulty accessing care, which may lead to delayed diagnosis and longer hospitalizations. Minority providers may positively affect the health of an increasingly diverse population.


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References and Recommended Reading

  1. 1.
    US Department of State: U.S. Minorities Will Be the Majority by 2042, Census Bureau Says. Available at Accessed March 12, 2009.
  2. 2.
    US Census Bureau: Population Projections: U.S. Interim Projections by Age, Sex, Race, and Hispanic Origin: 2000–2050. Available at Accessed March 12, 2009.
  3. 3.
    Manchester J, Topoleski J: Growing Disparities in Life Expectancy. Economic and Budget Issue Brief. A Series of Issue Summaries from the Congressional Budget Office. Washington, DC: Congress of the United States; Congressional Budget Office; 2008.Google Scholar
  4. 4.
    Miniño, AM, Heron MP, Smith BL: Deaths: preliminary data for 2004. Natl Vital Stat Rep 2006, 54:1–49.Google Scholar
  5. 5.
    US Census Bureau: The Face of Our Population. Available at Accessed March 12, 2009.
  6. 6.
    Bahrami H, Kronmal R, Bluemke DA, et al.: Differences in the incidence of congestive heart failure by ethnicity the Multi-Ethnic Study of Atherosclerosis. Arch Intern Med 2008, 168:2138–2145.CrossRefPubMedGoogle Scholar
  7. 7.
    Lloyd-Jones D, Adams R, Carnethon M, et al.: Heart disease and stroke statistics—2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2009, 119:480–486.CrossRefPubMedGoogle Scholar
  8. 8.
    Victor RG, Leonard D, Hess P, et al.: Factors associated with hypertension awareness, treatment, and control in Dallas County, Texas. Arch Intern Med 2008, 168:1285–1293.CrossRefPubMedGoogle Scholar
  9. 9.
    Douglas JG, Bakris GL, Epstein M, et al.: Management of the high blood pressure in African Americans: consensus statement of the Hypertension in African Americans Working Group of the International Society on Hypertension in Blacks. Arch Intern Med 2003, 163:525–534.CrossRefPubMedGoogle Scholar
  10. 10.
    Morales LS, Elliott M, Weech-Maldonado R, Hays RD: The impact of interpreters on parents’ experiences with ambulatory care for their children. Med Care Res Rev 2006, 63:110–128.CrossRefPubMedGoogle Scholar
  11. 11.
    Enas EA, Mohan V, Deepa M, et al.: The metabolic syndrome and dyslipidemia among Asian Indians: a population with high rates of diabetes and premature coronary artery disease. J Cardiometab Syndr 2007, 2:267–275.CrossRefPubMedGoogle Scholar
  12. 12.
    Russell M, de Simone G, Resnick HE, Howard BV: The metabolic syndrome in American Indians: the Strong Heart Study. J Cardiometab Syndr 2007, 2:283–287.CrossRefPubMedGoogle Scholar
  13. 13.
    Green AR, Carney DR, Pallin DJ, et al.: Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients. J Gen Intern Med 2007, 22:1231–1238.CrossRefPubMedGoogle Scholar
  14. 14.
    Johnson JA: Ethnic differences in cardiovascular drug response. Potential contribution of pharmacogenetics. Circulation 2008, 118:1383–1393.CrossRefPubMedGoogle Scholar
  15. 15.
    US Food and Drug Administration; Center for Drug Evaluation and Research: Coumadin labeling. New Labeling Information for Warfarin (marketed as Coumadin). Available at Accessed March 12, 2009.
  16. 16.
    ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial: Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002, 288:2981–2997.CrossRefGoogle Scholar
  17. 17.
    Pepine CJ, Handberg EM, Cooper-DeHoff RM, et al.: A calcium antagonist vs a non-calcium antagonist hypertension treatment strategy for patients with coronary artery disease: the International Verapamil-Trandolapril Study (INVEST): a randomized controlled trial. JAMA 2003, 290:2805–2816.CrossRefPubMedGoogle Scholar
  18. 18.
    Dahlof B, Devereux RB, Kjeldsen SE, et al.: Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomized trial against atenolol. Lancet 2002, 359:995–1003.CrossRefPubMedGoogle Scholar
  19. 19.
    US Food and Drug Administration; Center for Drug Evaluation and Research: Cozaar labeling. Available at Accessed March 12, 2009.
  20. 20.
    Calhoun DA, Jones D, Textor S, et al.: Diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Hypertension 2008, 51:1403–1419.CrossRefPubMedGoogle Scholar
  21. 21.
    Wright JT, Bakris G, Green T, et al.: Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease. Results from the AASK Trial. JAMA 2002, 288:2421–2431.CrossRefPubMedGoogle Scholar
  22. 22.
    Turner ST, Schwartz GL, Chapman AB, Boerwinkle E: C825T polymorphism of the G protein beta(3)-subunit and antihypertensive response to a thiazide diuretic. Hypertension 2001, 37:739–743.PubMedGoogle Scholar
  23. 23.
    Sehgal AR. Overlap between whites and blacks in response to antihypertensive drugs. Hypertension 2004, 43:566–572.CrossRefPubMedGoogle Scholar
  24. 24.
    Chobanian AV, Bakris GL, Black HR, et al.: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003, 289:2560–2672.CrossRefPubMedGoogle Scholar
  25. 25.
    Beta-Blocker Evaluation of Survival Trial Investigators: A trial of the beta-blocker bucindolol in patients with advanced chronic heart failure. N Engl J Med 2001, 344:1659–1667.CrossRefGoogle Scholar
  26. 26.
    Dries DL, Exner DV, Gersh BJ, et al.: Racial differences in the outcome of left ventricular dysfunction. N Engl J Med 1999, 340:609–616.CrossRefPubMedGoogle Scholar
  27. 27.
    Ferdinand KC: Fixed-dose isosorbide dinitrate-hydralazine: race-based cardiovascular medicine benefit or mirage? J Law Med Ethics 2008, 36:458–463.CrossRefPubMedGoogle Scholar
  28. 28.
    Taylor AL, Ziesche S, Yancy C: Combination of isosorbide dinitrate in blacks with heart failure. N Engl J Med 2004, 351:2049–2057.CrossRefPubMedGoogle Scholar
  29. 29.
    McNamara DM, Tam SW, Sabolinski ML, et al.: G protein beta 3 subunit (GNB3) genotype predicts enhanced benefit of fixed-dose isosorbide dinitrate and hydralazine: fesults of the A-HeFT Trial [abstract 2174]. Circulation 2006, 114:II-442.Google Scholar
  30. 30.
    Fiscella K, Tancredi D: Socioeconomic status and coronary heart disease risk prediction. JAMA 2008, 300:2666–2668.CrossRefPubMedGoogle Scholar
  31. 31.
    Centers for Disease Control and Prevention (CDC): Racial/ethnic and socioeconomic disparities in multiple risk factors for heart disease and stroke—United States, 2003. MMWR Morb Mortal Wkly Rep 2005, 54:113–117.Google Scholar
  32. 32.
    Foraker RE, Rose KM, McGinn AP, et al.: Neighborhood income, health insurance, and prehospital delay for myocardial infarction: the Atherosclerosis Risk in Communities Study. Arch Intern Med 2008, 168:1874–1879.CrossRefPubMedGoogle Scholar
  33. 33.
    Mitchell R, Popham F: Effect of exposure to natural environment on health inequalities: an observational population study. Lancet 2008, 372:1655–1660.CrossRefPubMedGoogle Scholar
  34. 34.
    Kivimäki M, Shipley MJ, Ferrie JE, et al.: Best-practice interventions to reduce socioeconomic inequalities of coronary heart disease mortality in UK: a prospective occupational cohort study. Lancet 2008, 372:1648–1654.CrossRefPubMedGoogle Scholar
  35. 35.
    Agency for Healthcare Research and Quality: 2007 National Healthcare Quality Report. Rockville, MD: US Department of Health and Human Services; Agency for Healthcare Research and Quality; 2008. [AHRQ publication no. 08-0040.]Google Scholar
  36. 36.
    Agency for Healthcare Research and Quality: 2007 National Healthcare Disparities Report. Rockville, MD: US Department of Health and Human Services; Agency for Healthcare Research and Quality; 2008. [AHRQ publication no. 08-0041.]Google Scholar
  37. 37.
    Centers for Disease Control and Prevention (CDC): Cigarette smoking among adults—United States, 2007. MMWR Morb Mortal Wkly Rep 2008, 57:1221–1226.Google Scholar
  38. 38.
    Alexander GC, Sehgal NL, Moloney RM, Stafford RS: National trends in treatment of type 2 diabetes mellitus, 1994–2007. Arch Intern Med 2008, 168:2088–2094.CrossRefPubMedGoogle Scholar
  39. 39.
    Rhee MK, Ziemer DC, Caudle J, et al.: Use of a uniform treatment algorithm abolishes racial disparities in glycemic control. Diabetes Educ 2008, 34:655–663.CrossRefPubMedGoogle Scholar
  40. 40.
    US Department of Health and Human Services: Eliminating Health Disparities: Strengthening Data on Race, Ethnicity, and Primary Language in the United States. Available at Accessed March 12, 2009.
  41. 41.
    Ix JH, Allison MA, Deneberg JO, et al.: Novel cardiovascular risk factors do not completely explain the higher prevalence of peripheral arterial disease among African Americans. The San Diego Population Study. J Am Coll Cardiol 2008, 51:2347–2354.CrossRefPubMedGoogle Scholar
  42. 42.
    Sequist TD, Fitzmaurice GM, Marshall R, et al.: Physician performance and racial disparities in diabetes mellitus care. Arch Intern Med 2008, 168:1145–1151.CrossRefPubMedGoogle Scholar
  43. 43.
    Jacoby MB, Sullivan TA, Warren E: Medical problems and bankruptcy filings. Norton’s Bankruptcy Law Adviser. May 2000. Cited in: Institute of Medicine, Committee on the Consequences of Uninsurance: Insuring America’s Health: Principles and Recommendations. Washington, DC: National Academy Press; 2004.Google Scholar
  44. 44. Kaiser Health Disparities Report: A Weekly Look at Race, Ethnicity and Health. Available at Accessed March 12, 2009.
  45. 45.
    US Department of Health and Human Services: Healthy People 2010. Leading Health Indicators. Available at Accessed March 12, 2009.
  46. 46.
    Nielsen-Bohlman L, Panzer AM, Kindid DA: Health Literacy: A Prescription to End Confusion. Washington, DC: National Academy Press; 2004.Google Scholar
  47. 47.
    US Department of Health and Human Services; Office of Minority Health: Think Cultural Health: Bridging the Health Care Gap Through Cultural Competency Continuing Education Programs. Available at Accessed March 12, 2009.
  48. 48.
    Francis CK, Alpert JS, Clark LT, et al.: Working group 3: how to encourage more minorities to choose a career in cardiology. J Am Coll Cardiol 2004, 44:241–245.CrossRefPubMedGoogle Scholar
  49. 49.
    Hayes B: Increasing the representation of underrepresented minority groups in US colleges and schools of pharmacy. Am J Pharm Educ 2008, 72:14.PubMedGoogle Scholar
  50. 50.
    Saha S, Guiton G, Wimmers PF, Wilkerson L: Student body racial and ethnic composition and diversity-related outcomes in US medical schools. JAMA 2008, 300:1135–1145.CrossRefPubMedGoogle Scholar
  51. 51.
    Institute of Medicine Committee on Quality of Health Care in America: Crossing the Quality Chasm: A New Health System for the 21st Century. Washington DC: National Academy Press; 2001.Google Scholar

Copyright information

© Current Medicine Group, LLC 2009

Authors and Affiliations

  1. 1.Association of Black CardiologistsAtlantaUSA

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