Heart risks still higher in blacks than whites
NEW YORK (Reuters Health) - Black men and women are more likely to die of a heart attack or heart failure than whites in the United States, according to a new study.
Researchers said those disparities could be explained by black adults' higher rates of smoking, diabetes and high blood pressure, and the finding that they tend to be heavier than whites.
The study's lead author said the result is "distressingly similar" to racial differences seen in data from the 1990s, despite public health efforts to address them.
"The sad fact is, we really don't see an awful lot of movement in terms of that long-standing disparity. It's pretty much where we were the last time we looked at it," Dr. Monika Safford, from the University of Alabama at Birmingham, told Reuters Health.
Her team's findings are based on close to 25,000 middle-aged and older adults who had blood and urine tests and a general health check in 2003 through 2007. At that point, none of them had heart disease.
Over the next four-plus years, 659 people in the study developed any kind of heart disease, including heart attacks and heart failure. About one-third of those "events" were fatal.
Every year during the study, 4 in 1,000 black men died from heart disease, on average, compared to 1.9 of 1,000 white men, the researchers found. Among women, 2 in 1,000 blacks died of heart disease each year, compared to 1 in 1,000 whites.
Safford and her colleagues found the extra deaths in blacks could be explained by their higher heart risks to begin with. For example, close to one in three black men and women had diabetes at the study's onset, versus one in six white participants.
"There are no surprises here," Safford said.
She said genetics may put black adults at higher risk for uncontrolled high blood pressure. When it comes to high cholesterol, fewer of them are on statins. And blacks may not be accessing quit-smoking programs - or other preventive care - as often as whites.
"The question is, did they have problems before (dying of heart disease) that weren't picked up? And maybe it's because they're not getting the same quality healthcare," said Dr. Carl "Chip" Lavie, from the John Ochsner Heart and Vascular Institute in New Orleans, who wasn't involved in the new research.
"The obvious implications are, we need to do a better job in African Americans of getting their risk factors treated, and probably getting them to recognize symptoms of cardiovascular disease."
MORE ETHNIC DISPARITIES
Another report published alongside Safford's found heart-disease differences aren't limited to blacks and whites: among Latinos in the United States, cardiac risks were common but varied widely.
Of more than 15,000 Cubans, Dominicans, Mexicans, Puerto Ricans, and Central and South Americans living in four U.S. cities, researchers found 80 percent of men and 71 percent of women had at least one "risk factor" for heart disease. Those included diabetes, high cholesterol, high blood pressure, smoking and obesity.
Heart disease and related risks were more common among people who'd lived in the U.S. for longer, or were second- or third-generation immigrants.
Risks also varied by study participants' country of origin. Obesity and smoking, in particular, were most common among Puerto Ricans, Dr. Martha Daviglus from the University of Illinois at Chicago and her colleagues reported in the Journal of the American Medical Association.
She said some groups of Latinos, such as Puerto Ricans, appear to have more heart-related problems than white and black Americans, while others, like South Americans, tend to have fewer.
"They can't all just be considered one generic population," said Dr. Patrick O'Malley, an internist at the Uniformed Services University of the Health Sciences in Bethesda, Maryland who didn't participate in the new studies.
"What we knew until now was based on a group of Hispanics, mainly Mexican-Americans, and as you can see, risk factors vary among all of the other Hispanic/Latino groups," Daviglus told Reuters Health.
That's because people from different countries eat and exercise in different ways, have different degrees of cultural acceptance when it comes to smoking, and adapt to living in the U.S. differently, she said.
Across the board, the average 45-year-old man has a 60 percent chance of having a stroke, heart attack or heart disease sometime in his life, according to another analysis of multiple long-term studies. A 45-year-old woman has a 56 percent risk.
Even middle-aged adults who are non-smokers, normal weight and have no other heart risks have a more than 30 percent chance of eventually developing heart disease, a team led by Dr. John Wilkins of Northwestern University in Chicago concluded.
Safford and Daviglus both emphasized the importance of targeting health and education programs to people in communities that need them, whatever their race or ethnicity.
"We need to educate these communities, we need to provide them means to improve their lifestyle," according to Daviglus - such as with free quit-smoking programs and exercise classes.
"The good news is that we know what the fixes are - now we just have to buckle down and do them," Safford said.
O'Malley told Reuters Health that although doctors should be more aware of higher risks for blacks and some Latinos - and possibly treat those patients more aggressively - issues such as economic and educational disparities will have to be addressed to create significant changes in health trends.