What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Cardiovascular disease (n=17355). Intervention: Ethnic minority status (Black, Asian, Hispanic) vs. White adults. Primary outcome: Prevalent CVD and CVD mortality.

March 26, 2025Open Access

Ethnic variations in cardiovascular disease (CVD) risk factors and associations with prevalent CVD and CVD mortality in the United States

QCQueenie CheungYork University SWSean WhartonWestern University AJAndrea R. JosseBrock University

Key Result

Black and Hispanic adults in the U.S. carried a heavier burden of cardiovascular risk factors and experienced significantly greater CVD mortality risk associated with hypertension and type 2 diabetes compared to White adults.

Study Design

Type

Cross-Sectional (n=17,355)

Structured PICO

Do socioeconomic and metabolic CVD risk factors relate differently to prevalent CVD and CVD mortality across ethnic groups in the United States?

Population

17,355 adults aged 40-80 years from the United States (NHANES 2011-2020) classified as White, Black, Asian, or Hispanic, excluding those underweight or with missing data.

Intervention

Presence of cardiovascular disease (CVD) risk factors (physical inactivity, obesity, hypertension, type 2 diabetes, lack of health insurance, low family income) across different ethnic groups (Black, Asian, Hispanic).

Comparator

White adults and individuals without the specific CVD risk factors.

Outcome

Prevalent CVD (self-reported myocardial infarction, coronary heart disease, or stroke) and CVD mortality (ICD-10 codes I00-I09, I11, I13, I20-I51).hard clinical

Socioeconomic and metabolic risk factors relate differently to CVD outcomes among ethnic minority groups in the US, highlighting the need for tailored public health strategies to address health disparities.

Limitations

Cross-sectional design limits establishing causality
Reliance on self-reported data for prevalent CVD, physical activities, and medications may introduce reporting biases
Language barriers or lack of healthcare access may have resulted in missed diagnoses
Does not account for within-group heterogeneity for factors such as socioeconomic status
Combining all Asian and Hispanic subgroups into a single category may obscure potential differences

Abstract

OBJECTIVE: To explore the association between ethnicity and cardiovascular disease (CVD) risk factors, including physical inactivity, obesity, hypertension, type 2 diabetes (T2D), lack of health insurance and low family income in a nationally representative sample of U.S. adults. RESEARCH DESIGN AND METHODS: Adults from the National Health and Nutrition Examination Survey (NHANES 2011-2020, n = 17,355) were classified as having CVD risk factors based on both self-reported and metabolic data. Ethnic differences in how these CVD risk factors relate to prevalent CVD and CVD mortality was examined in Whites, Blacks, Asians and Hispanics. RESULTS: Compared to Whites, significant disparities were noted in several CVD risk factors in ethnic minorities, such as lower PA, lower income, and more prevalent metabolic risk factors. Blacks and Hispanics commonly had higher prevalent CVD risk as compared to Whites even after adjusting for income and metabolic risk factors. Physical inactivity was most strongly associated with prevalent CVD and CVD mortality among Whites and Blacks. There were no ethnic differences in the inverse association between income and prevalent CVD risk, but Blacks with low income were associated with the greatest elevated CVD mortality. Hypertension and T2D were similarly related with prevalent CVD across ethnic groups, but Blacks and Hispanics with hypertension or T2D were at greater CVD mortality risk as compared to Whites. CONCLUSION: Our study identified that socioeconomic and metabolic risk factors may relate differently to CVD outcomes among ethnic minority groups in the United States. Addressing these ethnic disparities in health warrants further investigation.

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