Cardiovascular Disease in Racial and Ethnic Minorities (eBook)

Foreword 8
Preface 10
Acknowledgment 14
Contents 15
Contributors 17
1 Cardiovascular Disease in Racial/Ethnic Minorities: Overview and Perspectives 19
1. Introduction 20
2. Current Concepts of Race and Ethnicity: Facts and Fallacies 21
3. Overview of CVD in Racial/Ethnic Minorities Chapters 23
3.1 Epidemiology of Cardiovascular Diseases and Risk Factors Among Racial and Ethnic Populations in the United States 23
3.2 Unmasking Racial/Ethnic Disparities in Cardiovascular Disease: Nutritional, Socioeconomic, Cultural and Healthcare-Related Contributions 23
3.3 Race and Genetics 24
3.4 Race, Genetics, and Cardiovascular Disease 25
3.5 Hypertension and Stroke in Racial/Ethnic Groups 26
3.6 Dyslipidemia in Racial and Ethnic Groups 26
3.7 Novel and Emerging Risk Factors in Racial/Ethnic Groups 27
3.8 Therapeutic Lifestyle Interventions in a Multicultural Society 28
3.9 Obesity and the Cardiometabolic Syndrome: Impact on Chronic Kidney Disease and CVD 28
3.10 Risk Calculation and Clustering within Racial/Ethnic Groups 29
3.11 Cardiovascular Imaging in Racial/Ethnic Populations: Implications for the Adequate Application of Cardiovascular Imaging Techniques Guided by Racial and Ethnic Risk 29
3.12 Unique Aspects of Vascular and Cardiac Ultrasound in Racial/Ethnic Groups 30
3.13 Heart Failure in Racial/Ethnic Populations 31
3.14 Minority Women and CVD 32
4. Perspectives on CV Morbidity/Mortality in Racial/Ethnic Minorities 32
5. Practical Approaches to Eliminating Disparities 33
6. Socioeconomic-Disadvantaged Status and CVD 35
7 Future Considerations 35
2 Epidemiology of Cardiovascular Diseases and Risk Factors Among Racial/Ethnic Populationsin the United States 40
1 Summary 40
2 Introduction 41
3 Strengths and Limitations of the Existing Epidemiologic Data 42
4 Life Expectancy and Summary Measures ofPopulation Health 43
5 Cardiovascular Risk Factors and Biomarkers 45
5.1 Self-Reported Behavioral and Lifestyle Risks 48
5.2 Prevalence and Trends in Measured Risk Factors 48
5.3 Emerging Risk Factors and Biomarkers of Cardiovascular Risk 53
5.4 Markers of Subclinical Cardiovascular Disease 54
6 Cardiovascular Morbidity 57
7 Access to Care and the Quality ofHealth CareDelivered 58
8 Progress Made in the Elimination ofHealth Disparities 59
9 Summary and Conclusions 61
3 Unmasking Racial/Ethnic Disparities inCardiovascular Disease: Nutritional, Socioeconomic, Cultural, and Health-Care-Related Contributions 68
1 Population-Based CVD Burden/Racial and Ethnic Disparities in CVD 69
2 Likely Causes of Population-Based Differences in CVD Burden by Race/Ethnicity 71
2.1 The Role of Genetics in Race/Ethnicity Disparities in CVD 72
2.2 Environmental Effects 73
2.3 Low Birth Weight 76
2.4 Dietary Nutrients and Physiologic Effects upon CVD 77
2.5 Dietary Nutrients, Socioeconomic Status, and Race 78
2.6 Physical Inactivity 79
2.7 Geography and Acculturation 79
3 Socioeconomic Status and Cardiovascular Disease 80
4 Cardiovascular Disease Disparities in Health-Care Settings 81
4.1 Coronary Ischemia and Myocardial Infarction 82
4.2 Hypertension, Hyperlipidemia, and Other Cardiovascular Risk Factors 82
4.3 Congestive Heart Failure 82
4.4 Health System and Provider Characteristics Linked to CVD Disparities 83
4.5 Proposed Solutions for Reducing/Eliminating CVD Health Disparities in Health-Care Settings 83
5 Cultural Competency and CVD Health Care 85
5.1 Health-Care Quality and the Underserved 85
5.2 Cultural Competency Defined 85
5.3 Cardiovascular Disease and Etiology 87
5.4 Laizze Faire or Fatalistic Attitudes 87
3.1 Summary 88
4 Race and Genetics 97
1 Introduction 98
2 How is Genetic Variation Structured? 99
3 Measure and use of Genetic Ancestry 101
4 Finding Disease Susceptibility Genes in Admixed Populations 103
5 Has Natural Selection Shaped Genetic Variation? 103
6 Conclusion 104
5 Race, Genetics and Cardiovascular Disease 108
1 Introduction 109
2 Predisposition 110
3 Screening 111
4 Pathophysiology 112
4.1 Health Disparities: The Role of Gender and Ethnicity 113
4.2 Ethnicity-Based Therapies 113
5 Pharmacogenetics 114
6 Future Directions 114
7 Conclusions And Recommendations 115
8 Glossary 115
9 Acknowledgments 116
6 Hypertension and Stroke in Racial/Ethnic Groups 118
1 Introduction 119
2 Epidemiology 120
3 Pathophysiology 121
3.1 Salt Sensitivity 121
3.2 Obesity and Sympathetic Nervous System 121
3.3 Endothelial Dysfunction 124
4 Management of Hypertension 127
4.1 Non-drug Therapy 127
5 New Treatment for Hypertension 127
5.1 Hypertension in Hispanics 128
5.2 Hypertension in Asians 128
6 Epidemiology of Stroke 129
7 Pathophysiology of Stroke 129
7.1 Traditional Risk Factors 129
7.2 Novel Risk Factors 130
7.3 Risk of Stroke 130
7.4 Treatment of Stroke 130
8 Conclusions 132
7 Dyslipidemia in Racial/Ethnic Groups 134
1 Introduction 135
2 Dyslipidemia and CVD in African-Americans 136
2.1 Dyslipidemia 137
2.2 Total and Low-Density Lipoprotein (LDL) Cholesterol 137
2.3 Undertreatment of Dyslipidemia in African-Americans 138
2.4 High-Density Lipoprotein Cholesterol (HDL-C) 138
2.4.1 HDL-Raising as a Therapeutic Target 139
2.4.2 Torcetrapib 140
2.4.3 NCEP Recommendations for Low HDL-C 140
2.4.4 Mechanism of Higher HDL Levels in AA 140
3 Elevated Triglycerides 141
3.1 Management of Hypertriglyceridemia 141
4 Lipoprotein (a) 142
5 Risk Factor Clustering 142
6 Metabolic Syndrome 142
6.1 Management of the Metabolic Syndrome 144
7 Clinical Trials 144
7.1 ALLHAT 145
7.2 ARIES 145
7.3 NEPTUNE II 146
8 Hispanic Americans 146
9 South Asians 147
10 Native Americans (American Indians) 148
7.1 Summary and Conclusions 148
8 Novel Emerging Risk Factors in Racial/Ethnic Groups 154
1 Introduction 155
2 Homocysteine 155
3 Lipoprotein(a) 158
4 Inflammatory Markers 160
4.1 C-Reactive Protein (CRP) 160
4.2 Interleukin-6 (IL-6) 161
5 Conclusions 162
9 Weight Loss Interventions toControlBlood Pressure inanIncreasinglyOverweight, Multi-ethnic Society 166
1 Introduction 167
2 Epidemiology of Obesity 168
3 Prevalence of Overweight and Obesity 168
3.1 Age 169
3.2 Sex 169
3.3 Race/Ethnicity 169
3.4 Trends in Obesity Prevalence 172
4 Weight and Blood Pressure 172
4.1 Observational Epidemiology 173
4.2 Behavioral Interventions to Accomplish Weight Loss 173
4.3 Effects of Behavioral Interventions on Weight Loss 174
4.4 Effects of Behavioral Weight Loss Interventions on Blood Pressure 174
4.5 Weight Loss as a Means to Prevent Hypertension 176
4.6 Maintenance of Weight Loss 177
4.7 Strategies to Reduce BP in the Absence of Weight Loss 178
5 Effects of Behavioral Weight Loss Interventions inAfrican-Americans 178
5.1 Multi-ethnic Randomized Controlled Trials of Weight Loss Interventions 179
5.2 Targeted, Culturally Adapted Weight Loss Interventions in African-Americans 184
5.3 Church and Faith-Based Targeted, Culturally Adapted Interventions 185
5.4 Possible Reasons for Differences in Weight Loss Among Black and White Women 192
5.4.1 Modifiable Behavioral Differences 193
5.4.2 Physiological Differences 194
6 Effects of Behavioral Weight Loss Interventions in Other Racial/Ethnic Minority Populations 194
6.1 Hispanic Americans 195
6.2 Asian Pacific Islanders/Native Hawaiians 195
6.3 Native Americans/American Indians 201
9.1 Conclusions 201
10 Obesity and the Cardiometabolic Syndrome: Impact on Chronic Kidney Disease and CVD 207
1 Introduction 208
2 Cardiometabolic Syndrome: A Cluster of CVD Risk Factors 209
2.1 CMS and Inflammatory Markers 212
2.2 The Link Between CMS, T2DM, and ESRD 212
3 Impact of Obesity and the CMS on Development of CKD 213
4 Role of Obesity, Insulin Resistance, and Compensatory Hyperinsulinemia 213
5 Role of Reninangiotensinaldosterone System in the Pathogenesis of CKD in the Context of the CMS 215
6 The Role of Oxidative Stress 215
7 Impact of Obesity and the CMS on Development of Cardiovascular Disease (CVD) 217
8 Microalbuminuria 217
9 Visceral Obesity 218
10 Hypertension 218
11 Atherogenic Dyslipidemia 218
12 Hypercoagulability 219
13 Therapy: Influence of Ethnicity and Perspectives 219
14 Conclusion 223
11 Risk Calculation and Clustering Within Racial/EthnicGroups 228
1 Background 229
2 European Comparative Outlook 233
3 III Cardiovascular Risk Estimation in Asians 235
4 Cardiovascular Disease Risk Estimation in the African-American Population 235
5 Future Directions for CHD Risk Estimation 239
6 Summary 239
12 Cardiovascular Imaging in Racial/Ethnic Populations: Implications for the Adequate Application of Cardiovascular Imaging Techniques Guided by Racial/Ethnic Risk Factor Variations 241
1 Introduction 242
2 Prospective Epidemiologic Analysis 243
2.1 THE MESA TRIAL: Study Design with Respect to Cardiovascular Imaging 243
2.2 The Third National Health and Nutrition Examination Survey (NHANES III): Racial/ethnic Risk Factor Variations as the Reason for Cardiovascular Imaging Differences 244
3 Identification of the Presence of CAD 245
4 Imaging Techniques 245
4.1 Nuclear Stress Imaging -- Pharmacologic and Exercise 245
4.2 Echocardiography -- Transthoracic, Transesophageal, Stress Echocardiography, and Carotid Intima/Media Thickness Assessment 247
4.3 Computed Tomography Cardiac-Gated Electron-Beam Computed Tomography or Multi-detector ECG-Triggered Acquisition CT Scanning for Coronary Calcium Scoring and Coronary Angiography 248
4.4 Cardiac Magnetic Resonance Imaging-Function and Delayed Enhancement as well as Stress Perfusion 250
5 Implications for Cardiac Imaging inRacial/Ethnic Populations 251
5.1 Technique Selection 251
5.2 Diagnostic Bias and Prognostication 252
5.3 Clinical Application of Cardiac Imaging Techniques in High-Risk Ethnic Groups 253
6 Conclusions 253
13 Unique Aspects of Vascular and Cardiac Ultrasound in Racial/Ethnic Groups 258
1 Introduction 259
2 Left Ventricular Hypertrophy 259
3 Systolic And Diastolic Left Ventricular Heart Failure 265
4 Ultrasound Imaging In Infiltrative Disease 268
5 Other Cardiomyopathies 269
5.1 Hypertrophic Cardiomyopathy in Athletes 269
5.2 Left Ventricular Noncompaction 269
6 Obesity 273
7 Kawasaki Disease 274
8 Future Considerations 276
14 Heart Failure in Racial/Ethnic Groups 280
1 Overview 281
2 Epidemiology and Variance of Heart Failure in Minority Groups 282
3 Theories of Disparate Cardiovascular Care 283
4 Genetic Variation in Minority Groups 285
4.1 Beta (ß1Arg389) and Alpha ( 2cDel322-325) Receptor Polymorphism 285
4.2 Nitric Oxide and NOS3 286
4.3 Aldosterone Synthase (CYP11B2-C344-T) 287
5 Evidence-Based Medical Therapy for Minorities with Heart Failure 288
5.1 Beta-Blockers 289
5.2 Angiotensin-Converting Enzyme Inhibitors (ACE-I) 290
5.3 Angiotensin Receptor Blockers (ARBs) 291
5.4 Aldosterone Antagonists or Blockers 291
5.5 Isosorbide Dinitrate/Hydralazine Therapy (ISDN/HYD) 291
6 The A-HeFT Experience 297
7 Device and Surgical Therapy for Heart Failure 299
8 Conclusion 302
15 Minority Women and Cardiovascular Disease 308
1 Introduction 310
2 Epidemiology of Cardiovascular Disease in Minority Women 310
3 Risk Factors 311
3.1 Traditional Risk Factors 311
3.1.1 Obesity and Metabolic Syndrome 311
3.1.2 Hypertension 312
3.1.3 Left Ventricular Hypertrophy 313
3.1.4 Diabetes 313
3.1.5 Tobacco 313
3.1.6 Sedentary Life Style 314
3.2 Non-traditional Risk Factors 314
3.2.1 High-Sensitivity C-Reactive Protein 314
3.2.2 Anemia 315
3.2.3 Retinal Artery 315
3.2.4 Race-Specific Risk Factors 315
3.2.5 Vitamin E 316
3.2.6 Aspirin for Primary Prevention 316
3.2.7 Hormone Replacement 317
4 Assessment in Women 317
4.1 Stress Testing 317
4.2 SPECT Imaging 318
4.3 Stress Echocardiography 319
4.4 Coronary Calcium Score EBCT 320
4.5 What Is the Best Noninvasive Diagnostic Test for Women? 320
5 Varied Presentation 320
5.1 Chest Pain 321
6 Angina with Non-Obstructive Coronary Disease 321
6.1 Pathology-Endothelial Function 321
6.2 Evaluation for Endothelial Dysfunction 322
6.3 Treatment 322
7 Heart Failure 323
8 Prognosis 323
8.1 Etiology 323
8.2 Management and Response to Different Treatments 324
9 Conclusion 325
Subject Index 332