Albert Michelle A, Ravenell Joseph, Glynn Robert J, Khera Amit, Halevy Nitsan, de Lemos James A
Cardiovascular Division, Brigham and Women's Hospital, Boston, MA 02115, USA.
Am Heart J. 2008 Dec;156(6):1103-9. doi: 10.1016/j.ahj.2008.07.027. Epub 2008 Nov 6.
The objective of the study was to evaluate the association between race/ethnic (r/e) discrimination and subclinical cardiovascular disease (CVD). Although r/e discrimination is a chronic stressor that might have negative health effects, cardiovascular data related to experiences with discrimination among different r/e groups in the United States remain sparse.
Using data from the Dallas Heart Study, we assessed the association between perceived r/e discrimination and traditional CVD risk factors, C-reactive protein (CRP), aortic plaque area and wall thickness, and coronary calcium (CAC) score among black, white, and Hispanic participants. Prevalent CAC was defined as a CAC score > or =10 Agatston units; CRP elevation was defined as > or =3 mg/L. Participants were asked, "Have you ever been discriminated against due to your race/ethnicity? (responses: yes, no, or don't know)".
Blacks reported r/e discrimination more frequently than whites or Hispanics (P < .0001). Blacks who reported r/e discrimination were more likely to be college graduates, to have a family history of myocardial infarction, and to be more physically active than blacks who did not report r/e discrimination (each P < .05). Hispanics who reported r/e discrimination had a higher prevalence of smoking (P < .01) and were more likely to be born in the United States. In models that adjusted for traditional CVD risk factors and medication use, we generally found no association between reports of r/e discrimination and aortic wall thickness, aortic plaque area, prevalent CAC, or elevated CRP in any of the r/e groups. Among blacks, stratification by gender and education did not change the observed relationship between perceived r/e discrimination and CAC or CRP.
Although perceived r/e discrimination is associated with certain health characteristics that may result in negative health outcomes, in general, we found no association of r/e discrimination with either subclinical atherosclerosis as determined by CAC score, aortic wall thickness and aortic plaque area, or inflammation as assessed by elevated CRP levels.
本研究的目的是评估种族/族裔（r/e）歧视与亚临床心血管疾病（CVD）之间的关联。尽管r/e歧视是一种可能对健康产生负面影响的慢性应激源，但在美国，与不同r/e群体的歧视经历相关的心血管数据仍然很少。
利用达拉斯心脏研究的数据，我们评估了黑人、白人和西班牙裔参与者中，感知到的r/e歧视与传统CVD危险因素、C反应蛋白（CRP）、主动脉斑块面积和壁厚以及冠状动脉钙化（CAC）评分之间的关联。普遍存在的CAC定义为CAC评分≥10阿加斯顿单位；CRP升高定义为≥3mg/L。参与者被问及：“你是否曾因种族/族裔而受到歧视？（回答：是、否或不知道）”。
黑人报告r/e歧视的频率高于白人和西班牙裔（P<.0001）。报告r/e歧视的黑人比未报告r/e歧视的黑人更有可能是大学毕业生，有心肌梗死家族史，且身体活动更多（每项P<.05）。报告r/e歧视的西班牙裔吸烟率更高（P<.01），且更有可能在美国出生。在调整了传统CVD危险因素和药物使用情况的模型中，我们通常发现，在任何r/e群体中，r/e歧视报告与主动脉壁厚度、主动脉斑块面积、普遍存在的CAC或CRP升高之间均无关联。在黑人中，按性别和教育程度分层并未改变感知到的r/e歧视与CAC或CRP之间的观察关系。
尽管感知到的r/e歧视与某些可能导致负面健康结果的健康特征相关，但总体而言，我们发现r/e歧视与通过CAC评分、主动脉壁厚度和主动脉斑块面积确定的亚临床动脉粥样硬化或通过CRP水平升高评估的炎症均无关联。
