Among the various categories of CVD, coronary heart
disease (CHD) is the largest single cause of death in the American population.
When African Americans are compared to whites in this category, it is seen that
blacks have a higher death rate in the younger age groups but a lower rate at
older ages. Overall, CHD death rates in 1995 for black males were 133.1 per 1000
compared to 124.4 per 1000 for white males, or 7 percent higher in blacks; the
rates for black women were more than 35 percent higher than for white women
(81.6 versus 60.3 per 1000, respectively).
Heart attack event rates are higher for non-black men ages 65-74, but the
rate is more than twice as high for black as compared to white women in that
same age group. New and recurrent heart attacks occur more frequently in African
Americans men than in white men only in the 75-84 age category; in younger as
well as in older age groups, white men have more heart attacks than do African
Americans men. In addition, Gillum analyzed data from NHANES2 I and
found that the age-adjusted risk for
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CHD in
persons with no baseline history of the disease was higher for African Americans
women than for white women ages 25-74 but was lower for African American men
than for white men at all ages. Since risk factor levels tend to be higher in
African Americans, reduction of these multiple risk factors in this group could
lead to very dramatic reductions in CHD incidence if the risks were reduced only
to the levels present in whites. This fact represents one of the most hopeful
areas in disease management; since CHD age-adjusted fatality rates remain higher
for African Americans than for whites, the major killer of African Americans can
be significantly controlled through limitation of risk factors such as
hypertension, diabetes, and cigarette smoking. Reduction of CHD risk factors in
African American men and women just to the levels seen in whites should result
in a considerable saving of lives and represents one of the best possible
payoffs to public health efforts.
The number of studies of CHD in African Americans remains sparse, and except
for a few longitudinal
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epidemiological
studies, over the past two decades, randomized cardiovascular research
investigations providing data on CHD morbidity and mortality have included only
2-9 per cent African American patients in their study populations.
Recently, the National Heart, Lung and Blood Institute (NHLBI) and the Office
of Research on Minority Health (ORMH) initiated the Jackson Heart Study (JHS) in
an effort to overcome the severe information deficit which persists regarding
information on cardiovascular disease in blacks. Considered a black Framingham
Study, the JHS will build upon the current Atherosclerosis Risk in Communities
(ARIC) study which has been ongoing in Jackson, Mississippi for the past 13
years, based at the University of Mississippi Medical Center. One of the
principal goals of the JHS is to “identify risk factors for development and
progression of CHD, with emphasis on manifestations related to hypertension
(LVH, CHF, CHD, stroke and renovascular disease in African Americans.” This
appears to be the type of study needed to define the characteristics of
cardiovascular disease in African Americans. Its results will be awaited with
great interest.
Other investigations which should shed more light on cardiovascular disease
in African Americans are the Antihypertensive and Lipid-lowering Treatment to
Prevent Heart Attack Trial (ALLHAT), and the African American Study of Kidney
Disease (AASK). These trials are still in progress.
2 The National Health and Nutrition Examination
Survey (NHANES), conducted by the National Center for Health Statistics, Centers
for Disease Control (NCHS/CDC), is designed to assess the health and nutritional
status of adults and children in the United States through interviews and direct
physical examinations.
