Cardiometabolic multimorbidities increase mortality risk in Black adults
Black adults in the United States with multiple cardiometabolic morbidities are at increased risk for both all-cause and CHD mortality, according to a study.
“Given the known higher rates of mortality from CHD, stroke and diabetes among Black populations compared with white populations, it is paramount to examine the association of a combination of these cardiometabolic conditions with mortality among Black populations,” Joshua J. Joseph, MD, MPH, FAHA, assistant professor of medicine in the division of endocrinology, diabetes and metabolism at The Ohio State University Wexner Medical Center, and colleagues wrote.
In a prospective cohort study, Joseph and colleagues analyzed data from 5,064 Black adults aged 21 to 94 years from Jackson, Mississippi (63% women; mean age, 55.4 years; 18% with diabetes; 4% with CHD; 2% with history of stroke). The participants were examined as part of the Jackson Heart Study between 2000 and 2004, with a median follow-up period of 15.3 years.
Stratification by comorbidities
At baseline examination, participants were grouped into one of eight mutually exclusive categories: free of cardiometabolic morbidity; diabetes; CHD; stroke; diabetes and stroke; CHD and stroke; diabetes and CHD; and diabetes, stroke and CHD. The primary outcomes were all-cause mortality and CHD mortality.
Joseph and colleagues found that, compared with participants with no comorbidities, the rate of all-cause mortality significantly increased in participants with diabetes (HR = 1.5; 95% CI, 1.22-1.85), stroke (HR = 1.74; 95% CI, 1.24-2.42) and CHD (HR = 1.59; 95% CI, 1.22-2.08) alone. According to the researchers, the all-cause mortality risk also significantly increased in participants with a combination of diabetes and stroke (HR = 1.71; 95% CI, 1.09-2.68, CHD and stroke (HR = 2.23; 95% CI, 1.35-3.69) and diabetes and CHD (HR = 2.28; 95% CI, 1.65-3.15) compared with those with no comorbidities. Meanwhile, the greatest risk for all-cause mortality compared with no comorbidities occurred in participants who had a combination of diabetes, stroke and CHD (HR = 3.68; 95% CI, 1.96-6.93; P < .001), according to the researchers.
However, in terms of CHD mortality risk, researchers found that there was no significant increased risk for participants with diabetes alone (HR = 1.95; 95% CI, 0.96-3.97) or stroke alone (HR = 1.31; 95% CI, 0.31-5.59). Researchers found that there was an increased CHD mortality risk for participants with CHD alone (HR = 3.51; 95% CI, 1.56-7.9; P < .001), as well as the comorbidity groups of diabetes and stroke (HR = 5.57; 95% CI, 1.97-15.73), CHD and stroke (HR = 10.97; 95% CI, 4.12-29.22), diabetes and CHD (HR = 13.47; 95% CI, 6.54-27.74), and diabetes, stroke and CHD (HR = 13.52; 95% CI, 3.38-54.12).
‘A call to action’
“The multiplicative increased risk of all-cause and CHD mortality seen in this U.S. Black population is a call to action to prevent the development of cardiometabolic disease and advance the treatment of care of those with known cardiometabolic morbidities,” Joseph and colleagues wrote.
In addition, Joseph and colleagues wrote that the way these inequities are addressed must be changed.
“Much of the discussion on prevention revolves around individual lifestyle change, but appreciating that individual lifestyle change occurs in the environment and context of a person’s living situation and is impacted by the social determinants of health is critical to addressing inequities,” Joseph and colleagues wrote. “Intervening upstream in the sociopolitical and economic context, including structural racism and discrimination, accessible quality education and health care, socioeconomic status, and healthier built environments, could help to improve midstream determinants like nonmedical health-related social needs, which ... would help to improve CVD prevention and outcomes.”
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