Cardiovascular diseases: a review of the Hispanic perspective. Awareness is the first step to action.

Coronary heart disease is the leading cause of death in adults in the United States, accounting for about one-third of all deaths in subjects over age 35 (Thom et al., 1998). Mortality rates for cardiovascular disease and coronary heart disease in men and women and in blacks and whites have fallen in most countries by 24 to 28 percent since 1975, although the decline has slowed since 1990 (Kuulasmaa et al., 2000; McGovern et al., 1996; Capewell et al., 1999; Capewell et al., 2000; Cooper et al., 2000; McGovern et al., 2001; Gillum, 1994). This favorable trend is related partly to a decrease in the rate of fatal myocardial infarction (Gillum, 1987; Goldberg et al., 1988; Pashos et al., 1993; de Vreede et al., 1991), but it is also associated with a decline in the prevalence of risk factors for coronary artery disease (Gillium, 1994; Gillium 1987; Pearson, 1989). These risk factors strongly influence the severity of coronary atherosclerosis (Rhoads et al., 1978; Sorlie et al., 1981; Feinleib et al., 1979; Freedman et al., 1993; Reed and Yano, 1991), a major predictor of survival in patients with coronary disease (Humphries et al., 1974). These observations suggest that the decline in mortality from coronary artery disease is related to a parallel decline in coronary atherosclerosis. Despite great strides regarding the knowledge of coronary artery risk factors and some of its demographic aspects, the incidence and nature of each individual variable in certain ethnic and racial groups remain poorly defined. Over a decade ago the American Heart Association issued a statement regarding cardiovascular disease and stroke in racial minorities in the United States and urged for more participation of minority groups in research studies in order to assess their particular trends and outcomes (American Heart Association Medical/Scientific Statement, 1991). The purpose of this article is to review the current enrollment and participation of Hispanics in major clinical trials relating to cardiovascular disease and propose possible explanations for the observed results as well as suggestions to improve the shortcomings found.