CVD in African Americans
African Americans are at substantially higher risk for death from CVD than members of other ethnic groups. The rate of hypertension among African Americans is among the highest of any group in the world. Blacks tend to develop hypertension at an earlier age than whites do, and their average blood pressure is much higher. They also have a higher risk of stroke, have strokes at younger ages, and have more significant stroke-related disabilities. Some experts recommend that blacks be treated with antihypertensive drugs at an earlier stage when blood pressure reaches 130/80 rather than the typical 140/90 cutoff for hypertension.
A number of genetic and biological factors may contribute to CVD in African Americans. For example, blacks may be more sensitive to salt and have a physiologically different response to stress, which can lead to high blood pressure and other CVD risk factors. Low income is another factor in CVD risk and is associated with reduced access to adequate health care, insurance, and information about prevention. Discrimination may also play a role, both by increasing stress and by affecting treatment by physicians and hospitals.
Although these factors are important, some evidence favors lifestyle explanations for the higher CVD rate among African Americans. For example, black New Yorkers born in the South have a much higher CVD risk than those born in the Northeast. (Researchers speculate that some lifestyle risk factors for CVD, including smoking and a high-fat diet, may be more common in the South.) People with low incomes, who are disproportionately black, tend to smoke more, use more salt, and exercise less than those with higher incomes.
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The general preventive strategies recommended for all Americans may be particularly critical for African Americans. Tailoring your lifestyle to your particular ethnic risk may also be helpful in some cases. Discuss your particular risk profile with your physician to help identify lifestyle changes most appropriate for you.
High levels of a specific type of LDL called lipoprotein(a), or Lp(a), may be a risk factor for coronary heart disease (CHD), especially when associated with high LDL or low HDL levels. Lp(a) levels have a strong genetic component and are difficult to treat. About 33% of the U.S. population has elevated lipoprotein(a) levels. heart disease) than non-Hispanic white Americans. Asian Americans historically have had far lower rates of CVD than white Americans.
Inflammation Inflammation plays a key role in the development of CVD. When an artery is injured by hypertension, smoking, cholesterol, or other factors, the body’s response is to produce inflammation. A substance called C-reactive protein (CRP) is released into the bloodstream during the inflammatory response, and high levels of CRP indicate a substantially elevated risk of heart attack and stroke. CRP may also be harmful to the coronary arteries themselves. Gum disease involves another type of inflammation that may moderately influence the progress of coronary heart disease.
Lifestyle changes and certain drugs can reduce CRP levels. Statin drugs, widely prescribed to lower cholesterol, also decrease inflammation; this may be one reason that statin drugs seem to lower CVD risk even in people with normal blood lipid levels.
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