Reducing Disparities in CVD Between Blacks and Whites
How is the risk of fatal and fatal-plus-nonfatal cardiovascular disease (CVD) distributed among whites and blacks in the United States, and how would population-wide or targeted interventions on CVD risk factors reduce racial disparities if they exist?
The authors used data from seven rounds of the National Health and Nutrition Examination Survey (NHANES) 1999-2012 to estimate the distributions of risk and events in blacks and whites. The authors included black or white participants who were 50-69 years old and did not have a history of coronary heart disease or stroke. The authors estimated the effects of three types of interventions on CVD risk and events, as well as their disparities between blacks and whites: 1) population-wide interventions, 2) interventions to lower risk factor level among individuals with high levels for a single risk factor, and 3) a risk-based intervention that targeted individuals with high predicted 10-year CVD risk and treated several risk factors simultaneously.
The analysis included 6,154 participants; 25% (95% confidence interval [CI], 22-28) of black men were at high risk (≥6.67% of fatal CVD in 10 years) compared with only 10% (95% CI, 8-12) of white men. This high-risk subgroup accounted for 55% (95% CI, 49-59%) of CVD deaths in black men compared with 30% (95% CI, 24-35%) in white men. For women, 12% (95% CI, 10-14%) of blacks versus 3% (95% CI, 2-4%) of whites at high risk accounted for 42% (95% CI, 35-46%) of CVD deaths in blacks versus 18% (95% CI, 13-22) in whites. The risk-based multiple risk factor intervention could reduce absolute disparities by 415 per 100,000 (25%) in men and 423 (32%) in women.
A substantially larger proportion of blacks (25% of men and 12% women) in the United States had a high risk of fatal CVD than their white counterparts (10% of men and 3% of women). These high-risk individuals bore about half of the burden of fatal CVD events in the population.
This is a valuable study that corroborates previous analyses on disparities in risk factor exposure and their role as a cause of racial disparities in CVD. It is compelling that the authors demonstrate that a substantially larger proportion of blacks had a higher risk of fatal CVD than their white counterparts, and that this translated into nearly half the burden of fatal CVD events. Importantly, as the authors write, ‘an intervention that could identify high-risk individuals and treat multiple risk factors could both deliver large total benefits and substantially reduce absolute black-white disparities.’
Clinical Topics: Prevention
Keywords: African Americans, Cardiovascular Diseases, Coronary Disease, Primary Prevention, Risk Factors, Risk Reduction Behavior, Stroke
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