乌鸦传媒

Worsening cardiovascular health of white Americans over the past three decades has reduced persistent disparities in the heart health of minorities, researchers found.

Rates of optimal cardiovascular health – defined as a score of 10 or more on (LS7) – remain below 40% among whites, 25% among Mexican Americans, and 15% among African Americans, Arleen Brown, MD, PhD, of the University of California Los Angeles, and colleagues reported online in the .

The reduced disparities in CV health over time were most pronounced and consistent between whites and African Americans, and "were due to larger declines in LS7 scores for whites rather than gains in cardiovascular health among African Americans and Mexican Americans," the group noted.

Between 1988 and 2014, the proportion of whites with optimal cardiovascular health decreased by over 15% (95% CI 11.1 to 19.4%) for those in the youngest group (age 25-44) and by 4.6% (CI 2.7 to 6.5%) for those 65 years or older.

" shows consistent reductions in cardiovascular disease (CVD) mortality for all racial/ethnic groups. However, our findings of suboptimal control of risk factors in the population as a whole and declines in cardiovascular health among whites and some younger adults may foreshadow higher rates of heart disease and stroke and poorer outcomes from these conditions in the coming decades," Brown and colleagues wrote.

In an accompanying , George Mensah, MD, of the National Heart, Lung, and Blood Institute in Bethesda, Maryland, wrote: "Brown and colleagues deserve great credit for the simplicity of their message and the opportunity they offer. [While the observed] narrowing of disparities is no cause for celebration ... the good news is that the LS7 health factors and behaviors are simple to understand and provide the opportunity for everyone -- patients, providers, payers, policymakers, and public health practitioners -- to take action."

Life's Simple 7 (LS7) score reflects control of blood pressure, cholesterol and glucose levels, weight, physical activity, diet, and smoking. Lower LS7 scores are associated with higher all-cause and CVD-related death and higher incidence of CVD, stroke, heart failure, diabetes, cognitive impairment, depressive symptoms, and end-stage renal disease, the group noted.

Using National Health and Nutrition Examination Survey (NHANES) data, the researchers analyzed a nationally-representative, population-based, multi-year sample of U.S. adults with no prior cardiovascular disease (21,000 whites, 10,426 African Americans, almost 4,000 U.S.-born Mexican Americans, and about 5,500 non–U.S.-born Mexican Americans).

Across all five periods from 1988 to 2014, whites had a higher mean age, more years of education, and a higher income-to-poverty ratio than participants from the other racial and ethnic groups. Non–U.S.-born Mexican Americans were younger, more likely to be male, have fewer years of education, and a lower income-to-poverty ratio than the other groups.

In 1988 to 1994, African Americans ages 25 to 44 came in 23% lower on optimal LS7 scores than whites (CI 19% to 26%), while those 65 years of age or older had an 8% gap compared with whites (CI 6.4% to 10%). By 2011 to 2014, these differences had decreased to 10.6% for the youngest group and about 4% for the oldest group.

A similar but less pronounced trend was seen in decreasing disparities between whites and Mexican Americans, with the smallest and least consistent gaps noted relative to U.S.-born Mexican Americans. As with African Americans, differences were noted for almost all age groups in 1988 to 1994, generally decreased over time, and were greatest in the youngest age groups.

Individual risk factors varied considerably across the racial/ethnic and nativity groups. Improvements in cholesterol levels, smoking, and (in some age groups) blood pressure were countered by worsening hemoglobin A1c levels, BMI control, diet, and physical activity, authors wrote. "The long term effect of these diverging temporal changes in CVD risk factors and their implications for disparities in CVD and stroke require further study."

As in , "our analyses indicate the need for greater emphasis on prevention in all groups and earlier and more effective use of evidence based therapies to control CVD risk factors," the group concluded.

Study limitations included limiting the sample to whites, African Americans, and Mexican Americans, and including only persons without CVD, which may have underrepresented some groups at high risk for disparities, such as younger African Americans and Mexican American adults with early heart disease and stroke.

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