Carnethon Mercedes R, Lynch Elizabeth B, Dyer Alan R, Lloyd-Jones Donald M, Wang Renwei, Garside Daniel B, Greenland Philip
Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill 60611, USA.
Arch Intern Med. 2006 Jun 12;166(11):1196-202. doi: 10.1001/archinte.166.11.1196.
Recent attention to racial and ethnic disparities in health outcomes highlights the excess coronary heart disease mortality in black patients compared with white patients. We investigated whether traditional cardiovascular disease (CVD) risk factors were similarly associated with CVD mortality in black and white men and women.
Participants included 3741 black and 33,246 white men and women (44%) without a history of myocardial infarction, aged 18 to 64 years at baseline (1967-1973) from the Chicago Heart Association Detection Project in Industry study. Blood pressure, total cholesterol level, body mass index, cigarette smoking, and physician-diagnosed diabetes were assessed at baseline using standard methods.
Through 2002, there were 107, 1586, 177, and 2866 deaths from CVD in black women, white women, black men, and white men, respectively. In general, the magnitude and direction of associations between traditional risk factors and CVD mortality were similar by race. However, in black women the multivariable-adjusted hazard ratio (HR) per 12 mm Hg of diastolic blood pressure was 1.08 (95% confidence interval [CI], 0.90-1.29), whereas it was 1.31 in white women (95% CI, 1.25-1.38). There was no association between higher cholesterol level (per 40 mg/dL [1.04 mmol/L]) and CVD mortality in black men (HR, 0.94; 95% CI, 0.80-1.10), whereas the risk was elevated in white men (HR, 1.21; 95% CI, 1.16-1.26).
Most traditional risk factors demonstrated similar associations with mortality in black and white adults of the same sex. Small differences were primarily in the strength, not the direction, of association.
近期对健康结果中种族和民族差异的关注凸显了黑人患者相较于白人患者冠心病死亡率过高的情况。我们调查了传统心血管疾病（CVD）风险因素与黑人和白人男性及女性的CVD死亡率之间是否存在相似的关联。
参与者包括来自芝加哥心脏协会工业检测项目研究的3741名黑人和33246名白人男性及女性（44%），他们在基线时（1967 - 1973年）年龄为18至64岁，且无心肌梗死病史。在基线时使用标准方法评估血压、总胆固醇水平、体重指数、吸烟情况以及医生诊断的糖尿病。
到2002年，黑人女性、白人女性、黑人男性和白人男性中分别有107例、1586例、177例和2866例死于CVD。总体而言，传统风险因素与CVD死亡率之间关联的程度和方向在不同种族中相似。然而，在黑人女性中，舒张压每升高12毫米汞柱的多变量调整风险比（HR）为1.08（95%置信区间[CI]，0.90 - 1.29），而在白人女性中为1.31（95%CI，1.25 - 1.38）。在黑人男性中，较高的胆固醇水平（每升高40毫克/分升[1.04毫摩尔/升]）与CVD死亡率之间无关联（HR，0.94；95%CI，0.80 - 1.10），而在白人男性中风险升高（HR，1.21；95%CI，1.16 - 1.26）。
大多数传统风险因素在同性别的黑人和白人成年人中与死亡率的关联相似。微小差异主要体现在关联的强度而非方向上。
