Racial disparities present in cardiovascular, cardiometabolic disease risk factors

In a recent study, Mexican American adults and non-Hispanic Black adults in the United States had an overall greater prevalence of hypertension, obesity and diabetes mellitus compared with white adults and Asian adults.

The study also showed that few adults reported an ideal diet, highlighting the need for primary care providers to talk to patients about nutrition, Stephanie M. Lopez-Neyman, MS, MPH, RD, LD, a PhD candidate in the department of nutrition sciences at Texas Woman’s University, told Healio.

Writing in Scientific Reports, Lopez-Neyman and colleagues noted that health groups and government agencies release reports on CVD risk factors, but they do not examine CVD risk factors and cardiovascular health along with cardiometabolic risk factors, which can “increase the likelihood of diabetes and/or CVD development.”

“It would be beneficial to examine CVD risk factors and cardiovascular health jointly with cardiometabolic risk factors,” they wrote. “Those risk factors lead not only to the development of diabetes but also to CVD.”

The researchers analyzed data from the National Health and Nutrition Examination Survey (NHANES) that stretched from 2011 to 2018. Their analysis included 8,370 participants with no history of coronary heart disease or failure, myocardial infarction, stroke or angina pectoris.

Among the NHANES study sample, participants were predominately non-Hispanic white men (66%), and the mean age was 49 years.

The researchers focused on five CVD risk factors: hypertension, hypercholesterolemia, diabetes, smoking and obesity.

They also examined five risk factors for cardiometabolic disease: low high-density lipoprotein cholesterol (HDL-C), elevated triglycerides, glucose, homeostatic model assessment-insulin resistance (HOMA-IR) and high-sensitivity C-reactive protein (hsCRP). However, when calculating the sum of cardiometabolic risk factors, Lopez-Neyman and colleagues excluded HOMA-IR and hsCRP because these data were not available in the NHANES survey cycles from 2011 to 2015.

Overall, Lopez-Neyman and colleagues reported that hypertension (45%) and obesity (40%) were higher in prevalence than other CVD risk factors among participants, “with three-fourths (75%) having at least one CVD risk factor.”

The study revealed disparities in health metrics across racial and ethnic groups. Non-Hispanic Black adults had a higher prevalence of:

• hypertension (59.3%);
• obesity (50.2%); and
• diabetes mellitus (26.8%); and
• were more likely to be smokers (23.8%) compared with other groups.

“Thus, non-Hispanic Blacks were more likely than non-Hispanic Asians to have at least one CVD risk factor (83.2% and 60.9%, respectively),” the researchers wrote.

In addition, 50% of Mexican American adults had obesity and a higher prevalence of diabetes mellitus compared with non-Hispanic white adults (28.6% vs. 14.7%, P<0.001)

When looking at cardiometabolic risk factors, Lopez-Neyman and colleagues found that 51% of participants reported a fasting glucose plasma equal to or greater than 100 mg or hypoglycemic medication use, with Mexican Americans having the greatest prevalence (65.2%). In addition, 66% of participants had one of the three summed cardiometabolic risk factors (low HDL-C, elevated triglycerides and glucose).

In terms of cardiovascular health metrics, the researchers reported that non-Hispanic Asian adults had more ideal metrics, although they possessed the lowest prevalence of ideal physical activity (47%) compared with other races and ethnicities.

On a scale from zero to 14 points, the mean cardiovascular health score for all participants was 7.6 (95% CI, 7.5-7.7), indicating intermediate cardiovascular health, according to the researchers. The lowest mean score was among non-Hispanic Black adults, at 7.1 (95% CI, 7-7.2).

The researchers found that 95.2% of participants had at least one ideal cardiovascular health metric, while just 5.3% possessed all seven ideal metrics for diet, physical exercise, BMI, smoking status, BP, total cholesteryl and fasting plasma glucose. Of these, physical activity (59.2%) and smoking status (56.9%) were highest among participants, while ideal BMI (28.5%) and diet scores (10.4%) were low.

Since poor nutrition can exacerbate CVD risk factors, Lopez-Neyman recommended that PCPs talk to their patients about the Dietary Guidelines for Americans and select cultural foods that can fit into the guidelines.

“It is essential that PCPs listen to their patients about their dietary concerns to build a trusting relationship that brings about necessary health changes,” she said.

Lopez-Neyman also advocated for PCPs to consider working with a registered dietarian who can help to develop “culturally tailored nutrition handouts for a cardiovascular disease or cardiometabolic risk factor they want their patient to work on in conjunction with physical activity and the medication prescribed.”

Lopez-Neyman and colleagues highlighted several factors as potential causes for disparities, one of which being access to health insurance. Mexican Americans were found to have lower rates of insurance (43.2%), which “could partly explain their increased risk for CVD and cardiometabolic risk factors,” they wrote.

The researchers concluded that the findings provide “direction for researchers, health professionals, public health, and advocacy programs to address the most urgent risk factors among these race and ethnic groups."