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54.2 Ethnicity and cardiovascular risk factors
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Published:July 2018
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This version:April 2020
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Abstract
Significant variation is evident among different ethnicities regarding the prevalence, awareness, severity, treatment, and complications of major cardiovascular disease (CVD) risk factors. Relative to white Europeans, stroke mortality is almost doubled in South Asians and Afro-Caribbeans; however, when coronary artery disease mortality is considered, it is high in South Asians and low in Afro-Caribbeans. Hypertension is more common, severe, and is associated with higher rates of morbidity and mortality in black people than white people. Diabetes is more prevalent and less controlled in South Asians which leads to a nearly fourfold higher cardiovascular mortality in South Asians than other ethnic groups. Furthermore, South Asians suffer from a highly atherogenic lipid profile. In contrast, black people are generally known for their higher high-density lipoprotein and lower triglyceride levels than white people which seem to play a major role in protecting them from coronary artery disease. For a given waist circumference, Asian, black, and Caucasian people show different levels of intra-abdominal adiposity and CVD risk. Hence, the joint definition from five major organizations in 2009 of the metabolic syndrome set ethnic-specific values of waist circumference to define central obesity. Black Caribbean men have the highest rates of current smoking among all ethnic groups in the United Kingdom while nearly all South Asian and black African women are never-smokers. Varied genetic and lifestyle-related risk factors and their interactions seem to be responsible for the ethnic differences in CVD risk factors. There is a clear need for ethnic-specific guidelines for diagnosis and treatment of major CVD risk factors to maximize the outcomes of preventive strategies.
Update:
The important point that ‘black hypertensive patients exhibit a similar proportional reduction of cardiovascular and renal events in response ...More
Update:
The important point that ‘black hypertensive patients exhibit a similar proportional reduction of cardiovascular and renal events in response to blood pressure-lowering agents as white patientshas been added.
The goal blood pressure in black hypertensive patients was updated to 130/80 mmHg according to recent guidelines for management of hypertension.
The point that drug therapy for black hypertensive patients should be started with a two-drug combination including a calcium channel blockers and/or thiazide diuretic, either in combination or with a renin–angiotensin–aldosterone system blocker is included.
The point that drug therapy for hypertensive patients of ethnic groups other than blacks may be similar to white hypertensive patients has been added.
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