Cardiovascular disease is the leading cause of death in the U.S., with rates of cardiovascular death, and annual rates of first myocardial infarction by age being especially high in blacks, and striking differences seen in black women compared to white women (1).

This increased rate of disease in blacks can't however be explained on the basis of higher coronary artery calcium scores (2), but it is evident that this group exhibits differences in the prevalence of CHD risk factors (2) and risk factor clustering (3) compared to whites.

Clinical trials such as ALLHAT suggest different responsiveness to lipid-lowering drugs in blacks compared to whites (4), and Dr. Ferdinand discusses findings from the National Health and Nutrition Examination Survey showing lower rates of screening of dyslipidemia and achievement of lipid treatment goals in blacks compared to whites. Furthermore, in a large cohort study of women with established coronary artery disease, lower rates of drug use and risk factor control were found in black women compared to white women (5).

Asian Indians are another high-risk group in the U.S. with respect to cardiovascular mortality, and small studies suggest that impaired insulin-mediated vasodilation in this group (6) may play a role.

Dr. Ferdinand concludes his presentation by reviewing several studies showing differences in C-reactive protein levels among various ethnic groups ( 7-10), and an overview of special features of CHD risk factors in blacks (11).

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After viewing this presentation the participant will be able to discuss:

- Cardiovascular death rates in ethnic and minority populations in the U.S.
- Differences in the prevalence of CHD risk factors between blacks and whites
- CRP levels documented in various ethnic groups
- Special features of CHD risk factors in blacks

1. American Heart Association. “2004 Heart Disease and Stroke Statistics Update.”

2. Tulika Jain MD, Ronald Peshock MD, Darren K. McGuire MD, MHSc, DuWayne Willett MD, Zhoazia Yu MS, Gloria L. Vega PhD, Rudy Guerra PhD, Helen H. Hobbs MD, Scott M. Grundy MD, PhD, , and the Dallas Heart Study Investigators.African Americans and Caucasians have a similar prevalence of coronary calcium in the Dallas Heart Study JACC.2004;44(5):1011-1017.

3. Hutchinson RG, Watson RL, Davis CE, Barnes R, Brown S, Romm F, Spencer JM, Tyroler HA, Wu K. Racial differences in risk factors for atherosclerosis. The ARIC Study. Atherosclerosis Risk in CommunitiesAngiology. 1997 Apr;48(4):279-90.

4. The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group 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.

5. Ashish K. Jha, MD; Paul D. Varosy, MD; Alka M. Kanaya, MD; Donald B. Hunninghake, MD; Mark A. Hlatky, MD; David D. Waters, MD; Curt D. Furberg, MD, PhD; Michael G. Shlipak, MD, MPHDifferences in Medical Care and Disease Outcomes Among Black and White Women With Heart Disease Circulation. 2003;108:1089.

6. Annaswamy Raji, Marie D. Gerhard-Herman, Mercedes Warren, Stuart G. Silverman, Vassilios Raptopoulos, Christos S. Mantzoros and Donald C. Simonson Insulin Resistance and Vascular Dysfunction in Nondiabetic Asian Indians JCEM.2004;Vol. 89, No. 8 3965-3972.

7. Sonia S. Anand; Fahad Razak; Qilong Yi; Bonnie Davis; Ruby Jacobs; Vlad Vuksan; Eva Lonn; Koon Teo; Matthew McQueen; Salim YusufC-Reactive Protein as a Screening Test for Cardiovascular Risk in a Multiethnic PopulationArteriosclerosis, Thrombosis, and Vascular Biology. 2004;24:1509.

8. Michelle A. Albert MD, MPH, Robert J. Glynn PhD, Julie Buring ScD and Paul M. Ridker MD, MPHC-Reactive protein levels among women of various ethnic groups living in the United States (from the Women's Health Study)Am J Cardiol.2004;93(10):1238-1242.

9. Manisha Chandalia, Alberto V. Cabo-Chan, Jr, Sridevi Devaraj, Ishwarlal Jialal, Scott M. Grundy and Nicola Abate Elevated Plasma High-Sensitivity C-Reactive Protein Concentrations in Asian Indians Living in the United States JCEM.2003;88(8):3773-3776.

10. Michael J. LaMonte, PhD, MPH; J. Larry Durstine, PhD; Frank G. Yanowitz, MD; Tobin Lim, BS; Katrina D. DuBose, MS; Paul Davis, PhD; Barbara E. Ainsworth, PhD, MPH Cardiorespiratory Fitness and C-Reactive Protein Among a Tri-Ethnic Sample of Women Circulation. 2002;106:403.

11. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)JAMA. 2001;285:2486-2497.