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Declining cardiovascular health among white patients narrows racial disparity

Although racial disparities in cardiovascular health still exist, the divide between blacks and whites has narrowed because of worsening health among whites, not improvements among blacks, according to research published in Annals of Internal Medicine.

“Trends in cardiovascular disparities are poorly understood, even as diversity increases in the United States,” Arleen F. Brown, MD, PhD, from the University of California, Los Angeles, and colleagues wrote.

Brown and colleagues evaluated National Health and Nutrition Examination Survey data to determine the racial/ethnic trends and nativity disparities in cardiovascular health in the United States. The researchers included adults aged 25 years or older without CVD. They assessed differences in the Life’s Simple 7 (LS7) health factors and behaviors — BP, cholesterol, HbA1c, BMI, physical activity, diet and smoking — as well as a score for optimal cardiovascular health.

Data indicated that optimal cardiovascular health rates were below 40% for whites, 25% for Mexican Americans and 15% for blacks. There were persistent disparities in optimal cardiovascular health among whites and black, but they decreased over time.

Although racial disparities in cardiovascular health still exist, the divide between blacks and whites has narrowed because of worsening health among whites, not improvements among blacks.

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Fewer blacks aged 25 to 44 years had optimal LS7 scores than whites (adjusted difference: 22.8 percentage points; 95% CI, 19.3-26.4) as did those aged 65 years or older (adjusted difference: 8 percentage points; 95% CI, 6.4-9.7) in 1988 to 1994. These differences decreased to 10.6 percentage points (95% CI, 7.4-13.9) for those aged 25 to 44 years and 3.8 percentage points (95% CI, 2.5-5) those aged 65 years or older by 2011 to 2014.

There were smaller disparities in optimal LS7 scores among whites and Mexican Americans, but they also declined because whites showed reductions in optimal cardiovascular health across all age groups and time periods. From 1988-1994 to 2011-2014, there was a decrease of 15.3 percentage points (95% CI, 11.1-19.4) in optimal cardiovascular health for whites aged 25 to 44 years and a decrease of 4.6 percentage points (95% CI, 2.7-6.5 percentage points) for those aged 65 years or older.

“Our findings support the growing evidence suggesting that multifaceted strategies will be needed to improve the overall cardiovascular health of the population and associated health disparities,” Brown and colleagues concluded. “High-quality medical care can promote and sustain control of blood pressure cholesterol, and glucose and can play a pivotal role in encouraging behavior change related to diet, exercise and tobacco use. However, medical care alone cannot address worsening trends in risk factor profiles.

Community and policy interventions may improve health outcomes through decreased rates of and disparities in smoking, obesity, sedentary lifestyles, poor diet, and poor glycemic control. These risk factors present complex challenges, many of which will require multilevel, multisector approaches to intervene on biological and genetic risk, cultural norms, social networks, clinical care, the built environment, and food policy.”

In an accompanying editorial, George A. Mensah, MD, from the Center for Translation Research and Implementation Science at the National Heart, Lung and Blood Institute, noted that the findings by Brown and colleagues offer a timely opportunity for physicians, patients, payers, policymakers and public health practitioners to take action.

“The narrowing disparities is no cause for celebration... The good news is that the LS7 health factors and behaviors are simple to understand,” he wrote.

“The time has come for us to redouble our efforts in committing to the promotion of cardiovascular health and prevention and control of related risk factors, especially as we begin to craft the vision, mission, and plan of action for Healthy People 2030,” he added. – by Alaina Tedesco

Disclosure: Brown and Mensah report no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.