This chapter discusses racial and ethnic differences in cardiovascular risk and disease in the US. Race and ethnicity are social, political, historical, and cultural constructs; therefore, racial and ethnic differences observed in the incidence, prevalence, morbidity, and mortality of cardiovascular diseases should not be construed as necessarily resulting from genetic of other biological differences. Over the past decade or so, some progress has been made in some areas to reduce disparities in the burden of cardiovascular disease and the quality of health care, but most health disparities remain unchanged or have worsened. The primary drivers of persisting disparities include those attributed to cardiovascular health behaviors and risk factors (see accompanying Hurst’s Central Illustration); prominent racial and ethnic differences are seen in cardiovascular risk factors such as hypertension, overweight and obesity, dyslipidemia, physical inactivity, and smoking or tobacco use. Disparities in cardiovascular diseases/conditions, such as coronary heart disease, myocardial infarction, stroke, and congestive heart failure, are reported. Factors that account for the racial and ethnic differences in health behaviors, risk factors, disease burden, and associated morbidity and mortality operate at the levels of the individual patients, health care providers, health systems, health policies, and the communities within which patients live.
Reported disparities in cardiovascular risk factors and disease in US adults.
Race and ethnicity are social, political, historical, and cultural constructs.1,2 As such, they are flawed as biological concepts and inappropriate or, at best, imprecise when used as proxy for genetic or other biological phenomena.1,2,3,4,5 Consistent with this premise, racial and ethnic differences observed in the incidence, prevalence, morbidity, and mortality of cardiovascular diseases (CVD) should not be construed as necessarily resulting from genetic or other biological differences. Additionally, race and ethnicity are often confounded by socioeconomic status (SES). Thus, observed racial and ethnic differences that are not appropriately adjusted for SES and related factors could lead to erroneous conclusions with potentially adverse clinical and public health implications. Despite these challenges, data on race and ethnicity, when properly collected, analyzed, and interpreted, can be invaluable in clinical and public health practice.6,7,8 In particular, the appropriate collection and use of data on race and ethnicity are crucial in the quest to eliminate racial and ethnic disparities in cardiovascular health and advance health equity.9,10
In this chapter, we first address the historical origins and definitions of race and ethnicity, and how the terms have been used within the context of clinical and public health practice in the United States. The established racial and ethnic differences in the magnitude, distribution, outcomes, and trends of leading cardiovascular causes of morbidity and mortality are then presented with emphasis on their trends over the past 25 years. The role that research has played in advancing ...