Young Black adults at higher risk for early ASCVD than Hispanic peers
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Young Black adults living in a socially disadvantaged community were found to have greater risk for early subclinical atherosclerosis compared with young Hispanic adults in the same community, researchers reported.
Researchers posit that these findings from the FAMILIA study may be indicative of emerging or undiscovered CV factors attributable to atherosclerotic CVD risk among Black individuals, according to the results published in the Journal of the American College of Cardiology.
“This cross-sectional study of adult FAMILIA trial participants is one of the first to report the presence of 3D vascular ultrasound-assessed subclinical atherosclerosis in a young cohort of mainly women, from a socioeconomically disadvantaged community,” Josep Iglesies-Grau, MD, fellow on preventive cardiology at the Montreal Heart Institute, and colleagues wrote. “Subclinical atherosclerosis prevalence and atherosclerotic burden were both higher in the non-Hispanic Black group than in the Hispanic population, despite both groups having similar 10-year Framingham CV risk scores. These findings ... suggest that nontraditional or unknown risk factors could potentially work through distinct epigenetic pathways that might explain the earlier and more encroaching progression of subclinical atherosclerosis among the non-Hispanic Black population.”
The FAMILIA trial
The FAMILIA trial assessed the utility of a school-based educational intervention designed to improve knowledge, attitudes and heart-healthy lifestyle habits in 562 children (mean age, 4 years; 51% girls; 37% Black; 54% Hispanic/Latino) from 15 preschools in Harlem, New York.
As Healio previously reported, mean change in knowledge, attitudes and habits score was approximately 2.2-fold higher at 5 months among children assigned the intervention compared with controls assigned to no intervention.
The present analysis utilized bilateral carotid and femoral 3D vascular ultrasound in 436 parents and caregivers of the FAMILIA preschoolers as well as preschool staff to better elucidate any race/ethnic differences in the prevalence of early subclinical atherosclerosis.
All participants had no history of CVD (mean age, 38 years; 82% women; 66% Hispanic; 34% Black).
Racial differences in atherosclerotic risk
Age and sex did not differ significantly between racial/ethnic groups, according to the study.
Within this cohort, Black participants were more than three times more likely to be hypertensive (OR = 3.54; 95% CI, 2.14-5.87; P < .001) and three times more likely to be active smokers (OR = 3.15; 95% CI, 1.83-5.41; P < .001) compared with Hispanic participants. Black participants also had higher mean BMI (mean difference, 1.45 kg/m2; 95% CI, 0.17-2.74; P = .027) and had higher self-reported intake of fruits and vegetables (P < .001) compared with Hispanic participants.
Researchers observed no between-group difference in self-reported diabetes (P = .735), fasting glucose (P = .402) and total cholesterol (P = .873) between Black and Hispanic participants.
In the overall cohort, the average 10-year Framingham risk was 4%, with no differences seen by race/ethnicity.
The prevalence of early subclinical atherosclerosis was higher among Black compared with Hispanic participants (12.9% vs. 6.6%).
After adjustment for 10-year Framingham risk, BMI, fruit and vegetable consumption, physical activity and employment status, researchers reported that Black participants had a more than threefold greater risk for early subclinical atherosclerosis compared with Hispanic participants (OR = 3.45; 95% CI, 1.44-8.29; P = .006) and multi-territorial disease, defined as plaque seen in more than one region (P = .026).
“These results highlighted once again the critical importance of implementing health promotion and targeted CV prevention strategies, such as smoking cessation and blood pressure control,” the researchers wrote. “Efforts in this area should be targeted at the more affected vulnerable communities, where the largest net gains are likely to be made.”
References:
- Ferdinand KC. J Am Coll Cardiol. 2019;doi:10.1016/j.jacc.2019.02.024.
- Fernandez-Jimenez R, et al. J Am Coll Cardiol. 2019;doi:10.1016/j.jacc.2019.01.057.
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