The racial gap for cardiovascular health in America is narrowing, but the news isn’t as encouraging as it initially sounds.
It turns out the disparity is shrinking because whites are increasingly less healthy, not because of gains made by minority populations, lead author Arleen F. Brown, MD, PhD, and colleagues reported in the Annals of Internal Medicine. Higher blood sugar levels and body mass index, as well as poorer diet and exercise habits, are specifically to blame.
“Over time, whites—and to a lesser extent, U.S.-born Mexican Americans—had disproportionate increases in poor levels of physical activity and diet relative to most other groups,” Brown and coauthors wrote.
The researchers examined data from the National Health and Nutrition Examination Survey (NHANES) from 1988 to 2014. They used the Life’s Simple 7 (LS7) health factors developed by the American Heart Association to define optimal cardiovascular health. Each factor is rated on a scale of 0 to 2 for a total of 14 possible points; the authors considered scores of 10 and above “optimal.”
The Simple 7 factors include blood pressure, cholesterol and hemoglobin A1c levels, body mass index, physical activity, healthy diet score and smoking status.
For the entire study period, the rates of optimal cardiovascular health never exceeded 40 percent for whites, 25 percent for Mexican-Americans or 15 percent for blacks. Brown et al. noted blacks at the beginning of the study had optimal LS7 scores 22.8 percent less frequently than whites in the 25- to 44-year-old age group and 8 percent less often in the 65 and older group. By the end of the study (2011-2014), the differences decreased to 10.6 percent and 3.8 percent, respectively, for those age groups.
The researchers also highlighted a steady deterioration in the proportion of whites with optimal LS7 scores. The percentages were lower in every four-year period beginning in 1999 to 2002, and were 15.3 percent lower in 2011 to 2014 than they were from 1988 to 1994.
“Recent evidence shows consistent reductions in CVD mortality for all racial/ethnic groups,” the authors wrote. “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 noted the biggest disparities existed between African-Americans and whites, while U.S.-born Mexican-Americans were closest to matching whites in terms of cardiovascular health.
There was a bit of positive news in the report. Cholesterol levels and blood pressure (in some age groups) improved over time, and fewer people smoked. However, the rising rates of diabetes and obesity across the entire study cohort—coupled with worse diet and exercise regimens—deserves further attention, Brown and colleagues said.
“The long-term effect of these trends on heart disease and stroke incidence, case fatality, and mortality will depend on many factors, including socioeconomic differences; competing health and social risks; cultural factors; racial/ethnic variation in the effects of biological and behavioral risk factors on CVD; and differences in access to high-quality, evidence-based health care,” they wrote. “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.”
A major limitation of the study is it only compared whites, blacks and Mexican-Americans, not different Latino groups, Asian-Americans or other races/ethnicities.
In a related editorial, George A. Mensah, MD, said the study authors “deserve great credit” for highlighting the declining cardiovascular health of Americans and pointing out that racial disparities in this regard remain significant, even if they are narrowing. However, Mensah remains hopeful knowledge can be translated to action.
“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,” he wrote. “Individual behavioral and lifestyle changes will be necessary in promoting cardiovascular health for all, as will policy and environmental changes with population-wide impact.”
Daniel joined TriMed’s Chicago editorial team in 2017 as a Cardiovascular Business writer. He previously worked as a writer for daily newspapers in North Dakota and Indiana.