This article is more than 5 years old. Information may no longer be current.
Women, black adults face greater burden from CVD risk factors
The impact of major CV risk factors combined is greater in women than men and in black adults than white adults, according to a new report published in Circulation.
In particular, hypertension and diabetes play a significant role in these sex- and race-based differences.
“We’ve been targeting traditional risk factors in public health campaigns for many years,” Susan Cheng, MD, MPH, assistant professor of medicine at Brigham and Women’s Hospital in Boston, said in a press release. “We wanted to take a look at how well we’ve been doing over time at keeping these risk factors from causing heart and vascular disease — both by preventing the risks from occurring and by minimizing their effects when they do occur.”
Cheng and colleagues evaluated 13,541 participants in the Atherosclerosis Risk in Communities study. Of these, 56% were women, 26% were black and all were aged 52 to 66 years at baseline. The participants each underwent four examinations between 1987 and 1998, during which researchers evaluated risk factors including obesity, hypertension, hypercholesterolemia, diabetes and smoking status. Researchers also estimated the population attributable risks (PARs) of each risk exposure on 10-year CVD prevalence, according to risk factor prevalence at each examination. Follow-up continued through Dec. 31, 2008.
The overall PAR for all five risk factors decreased from 0.58 to 0.53 between the late 1980s and late 1990s, but the difference was not significant. The PAR for obesity remained consistent between the late 1980s and the late 1990s. Nonsignificant decreases were observed in the PAR for hypercholesterolemia, which decreased from 0.18 in 1987-1989 to 0.09 in 1996-1998 (P=.08), and for smoking, which decreased from 0.15 to 0.13 (P=.16).
“Our results don’t suggest that a risk factor like smoking has become any less dangerous, but that fewer people are smoking,” Cheng said. “In fact, for current smokers the risk of heart and vascular disease has actually gone up, possibly because remaining smokers tend to smoke more heavily or carry additional risk factors.”
From 1987 through 1989, the combined PAR was higher among women than men (0.68 vs. 0.51; P<.001); however, this difference was attenuated by the late 1990s (0.58 vs. 0.48; P=.08). In the late 1980s, the combined PAR was higher among black participants compared with white participants (0.67 vs. 0.57; P=.049); this disparity become wider by the late 1990s (0.67 vs. 0.48; P=.002).
The PAR for hypertension specifically was significantly greater among women during the late 1990s (0.32 vs. 0.19; P=.02), but not during the late 1980s (0.28 vs. 0.23; P=.23). In contrast, the PAR for hypertension was significantly higher among black participants compared with white participants during the late 1980s (0.4 vs. 0.21; P=.002), but not the 1990s (0.36 vs. 0.21; P=.08). The PAR for diabetes was higher among women and blacks in both the 1980s and 1990s (P<.0001 for all comparisons).
“In addition to persistently high PAR for the total sample, we observed that the contribution to incident CVD of all traditional risk factors combined is greater in blacks than whites, and this difference may be increasing with time,” the researchers concluded. “… These findings underscore the continued need for individual as well as population approaches to CVD risk factor modification.”
Disclosure: The researchers report no relevant financial disclosures.