Race and Venous Thromboembolism: Nature or Nurture?
Conventional teaching is that a racial gradient exists for the frequency of venous thromboembolism (VTE) in the United States. Asian-Americans have the lowest risk, and African-Americans have the highest risk. Hispanic Americans and Americans of European ancestry have an intermediate list, with Hispanics having less frequent VTE than those of European but non-Hispanic heritage. The most apparent paradox is that African-Americans have the highest rate of VTE, even though they rarely carry the prothrombin gene mutation or Factor V Leiden mutation, two genetic abnormalities that predispose to VTE. Based upon genetic profiling (nature), one might have predicted that African-Americans would have a low rate of VTE. In one study, when compared to European-ancestry individuals and adjusting for age and gender, African-Americans had a 30-60% higher incidence of VTE than European-Americans.1 This finding suggests that environmental and socioeconomic factors and perhaps healthcare disparities (nurture) play an important role in determining the risk of developing VTE.
- Received February 4, 2014.
- Accepted February 6, 2014.