Race, ethnicity affect heart disease risk, from the August 2015 Harvard Heart Letter

Published: August, 2015

In the United States, some racial and ethnic groups face a greater risk of dying from cardiovascular disease than others. But teasing out the reasons behind these disparities isn't easy, reports the August 2015 Harvard Heart Letter.

Many complex, intertwined factors contribute to the higher heart disease rates seen among some groups. Lower average income likely plays a large role. It affects where people live, which in turn affects their access to healthy food, safe places to exercise, and quality of health care. In other words, "your ZIP code is more important than your genetic code," says Dr. Eldrin F. Lewis, a cardiologist at Harvard-affiliated Brigham and Women's Hospital and associate professor of medicine at Harvard Medical School.

But even after adjustment for factors related to socioeconomic differences, disparities in rates of heart disease and its risk factors persist, Dr. Lewis says. For example, in the United States, nearly half of all black adults have some form of cardiovascular disease, compared with about one-third of all white adults. A genetic difference that predisposes blacks to high blood pressure might play a role in this.

In addition, compared with whites, Hispanics and Latinos have higher rates of cardiovascular risk factors such as obesity and diabetes. "Yet they appear to have lower rates of heart disease, which is counterintuitive," says Dr. Enrique Caballero, director of the Latino Diabetes Initiative at the Joslin Diabetes Center and assistant professor of medicine at Harvard Medical School. This so-called Hispanic paradox isn't well understood and may reflect underreporting of heart disease rates among these populations, as well as possible inaccuracies on death certificates regarding cause of death, notes Dr. Caballero.

Asian Indians, Chinese, and Filipinos are the three largest subgroups of Asian Americans in the United States. Among these groups, heart disease rates vary widely. Recent immigrants from East Asian countries tend to have lower rates of heart disease than other Americans. However, their children—who often adopt Western cultural practices—have higher rates of obesity and other cardiac risk factors. This underscores the role of lifestyle habits on heart health, notes Dr. Lewis.

Read the full-length article: "Race and ethnicity: Clues to your heart disease risk?"

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