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Thursday, May 24, 2007

Established Risk Factors Account for Most of the Racial Differences in Cardiovascular Disease Mortality PLoS ONE 2(4): e377 (2007)

Cardiovascular disease (CVD) mortality varies across racial and ethnic groups in the U.S., and the extent that known risk factors can explain the differences has not been extensively explored.

We examined the risk of dying from acute myocardial infarction (AMI) and other heart disease (OHD) among 139,406 African-American (AA), Native Hawaiian (NH), Japanese-American (JA), Latino and White men and women initially free from cardiovascular disease followed prospectively between 1993–1996 and 2003 in the Multiethnic Cohort Study (MEC).

Relative risks of AMI and OHD mortality were calculated accounting for established CVD risk factors: body mass index (BMI), hypertension, diabetes, smoking, alcohol consumption, amount of vigorous physical activity, educational level, diet and, for women, type and age at menopause and hormone replacement therapy (HRT) use.

In men and women in this cohort, the protective effect of alcohol consumption was seen in all racial groups (data not shown), findings consistent with those reported by others. In the MEC, the protective effect of alcohol was not dependent on the type of alcohol (red wine, beer, grain alcohol) consumed. While our results demonstrate an essentially linear decrease in AMI and OHD mortality with increasing alcohol consumption, there have been other reports indicating that this decreasing trend eventually begins to reverse. It is possible that alcohol consumption was too infrequent in the MEC to study this phenomenon. Alcohol was also associated with a significant and consistent decrease in mortality from more chronic forms of heart disease (OHD) in all the racialities studied.

Known risk factors explain the majority of racial and ethnic differences in mortality due to AMI and OHD. The unexplained excess in NH and AA and the deficits in JA suggest the presence of unmeasured determinants for cardiovascular mortality that are distributed unequally across these populations.

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