Discovering the Full Spectrum of Cardiovascular Disease
Authors: Emelia J. Benjamin, Mariell Jessup, John M. Flack, Harlan M. Krumholz, Kiang Liu, Vinay M. Nadkarni, Dorothy A. Rhoades, Beatriz L. Rodriguez, Rosalyn P. Scott, Malcolm P. Taylor, Eric J. Velazquez, Marilyn A. Winkleby
Journal: Circulation (2005)

D espite the steady decline in cardiovascular disease (CVD) mortality during the past 30 years, 1 CVD remains the No. 1 killer of adults across all racial/ethnic groups in the United States. 2 Observational studies have been central to understanding the epidemiology of CVD, including its incidence, prevalence, predictors, and prognosis.Until recently, the majority of epidemiological studies have been based predominantly, or even exclusively, on middle-class, white, non-Hispanic cohorts.Hence, the generalizability of the findings to all populations has been uncertain.][5] The present report highlights important findings from several of the key observational studies of CVD, which have examined CVD risk in racial/ethnic minority populations.These key studies include the National Health and Nutrition Examination Survey (NHANES), a US population-based study; the Honolulu Heart Program (HHP), a study of Japanese-American men; the Strong Heart Study (SHS), a study of American Indians; and the Multi-Ethnic Study of Atherosclerosis (MESA).The studies were selected to represent a variety of racial/ethnic groups and study designs.It should be emphasized that informative data from many other epidemiological observational studies are included; Internet links to additional cohort studies are available in the Appendix.Key references and Internet resources for the lay public and health professionals also are included in the text and the Appendix.Recommendations for future directions and efforts conclude this article. Observational Studies National Health and Nutrition Examination SurveyThe NHANES study has conducted periodic national examinations during the past 30 years to understand the epidemiology and temporal trends in CVD and risk factors in the US population.The NHANES study data played a central role in alerting the nation to the startling US epidemic in obesity, which has disproportionately affected racial/ethnic minorities. 6Kuczmarski et al, using 1988 to 1991 NHANES data, reported that 49% of black women and 47% of Mexican American women were overweight, as compared with 32% of white American women. 6Many descriptors of racial/ethnic disparities in CVD risk factors have used NHANES III, conducted from 1988 to 1994, which included an oversampling of black, Mexican American, and white non-Hispanic women and men from all socioeconomic levels.The distribution of CVD risk factors by ethnicity was highlighted by Winkleby et al using these data. 7Black and Mexican American women were more than twice as likely as were white women to be physically inactive during their leisure time and to have diabetes (Figure 1).Furthermore, black and Mexican American women had a higher mean body mass index (BMI) than did their white counterparts (29.2 and 28.6 kg/m 2 , respectively, versus 26.3 kg/m 2 ) and a higher mean systolic blood pressure. 7The risk factor burden of these racial/ethnic groups remained significant after adjustment for age and years of education, but they were less consistent and of lower magnitude for men (Figure 2). 8Ethnic minority men, both black and Mexican American, had a higher prevalence of diabetes, higher levels of systolic blood pressure (particularly