Widening Racial Differences in Risks for Coronary Heart Disease
This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
The incidence of coronary heart disease (CHD) has been declining in the United States,1 but this improvement appears to be lagging in blacks compared with whites.2 To understand race-based patterns in contributions to risk over time, we investigated temporal trends in the prevalence of major risk factors and their associated hazards for CHD in a large sample of black and white adults living in 4 different communities and followed up over the last 2 decades.
We examined age-adjusted temporal trends in the population-attributable risk (PAR) of major CHD risk factors (hypertension, hypercholesterolemia, diabetes mellitus, smoking, and obesity) using data collected continuously from 14 766 participants (27% black, 56% women) in the multicenter ARIC study (Atherosclerosis Risk in Communities) who were originally free of CHD and followed up from 1987 to 2013.3 Risk factors were defined according to the following criteria: hypertension as systolic blood pressure (BP) ≥140 mm Hg, diastolic BP ≥90 mm Hg, or antihypertensive medication use; hypercholesterolemia as total cholesterol ≥200 mg/dL or cholesterol-lowering medication use; obesity as body mass index ≥30 kg/m2; diabetes mellitus as fasting glucose ≥126 mg/dL, nonfasting glucose ≥200 mg/dL, or glucose-lowering medication use; and, current smoking as self-reported active smoking within 1 year. We used a single time-to-event model that considered calendar days as the time scale and treated vital status and all covariates (including risk factors and age) as time updated while standardizing all results to referent age 65 …