Juarez Paul D, Hood Darryl B, Song Min-Ae, Ramesh Aramandla
Meharry Medical College, Nashville, TN, United States.
College of Public Health, The Ohio State University, Columbus, OH, United States.
Front Public Health. 2020 Aug 12;8:379. doi: 10.3389/fpubh.2020.00379. eCollection 2020.
Obesity, diabetes, and hypertension have increased by epidemic proportions in recent years among African Americans in comparison to Whites resulting in significant adverse cardiovascular disease (CVD) disparities. Today, African Americans are 30% more likely to die of heart disease than Whites and twice as likely to have a stroke. The causes of these disparities are not yet well-understood. Improved methods for identifying underlying risk factors is a critical first step toward reducing Black:White CVD disparities. This article will focus on environmental exposures in the external environment and how they can lead to changes at the cellular, molecular, and organ level to increase the personal risk for CVD and lead to population level CVD racial disparities. The external environment is defined in three broad domains: natural (air, water, land), built (places you live, work, and play) and social (social, demographic, economic, and political). We will describe how environmental exposures in the natural, built, and social environments "get under the skin" to affect gene expression though epigenetic, pan-omics, and related mechanisms that lead to increased risk for adverse CVD health outcomes and population level disparities. We also will examine the important role of metabolomics, proteomics, transcriptomics, genomics, and epigenomics in understanding how exposures in the natural, built, and social environments lead to CVD disparities with implications for clinical, public health, and policy interventions. In this review, we apply an exposome approach to Black:White CVD racial disparities. The exposome is a measure of all the exposures of an individual across the life course and the relationship of those exposures to health effects. The exposome represents the totality of exogenous (external) and endogenous (internal) exposures from conception onwards, simultaneously distinguishing, characterizing, and quantifying etiologic, mediating, moderating, and co-occurring risk and protective factors and their relationship to disease. Specifically, it assesses the biological mechanisms and underlying pathways through which chemical and non-chemical environmental exposures are associated with CVD onset, progression and outcomes. The exposome is a promising approach for understanding the complex relationships among environment, behavior, biology, genetics, and disease phenotypes that underlie population level, Black: White CVD disparities.
近年来，与白人相比，非裔美国人中肥胖、糖尿病和高血压的发病率呈流行趋势增长，导致了严重的心血管疾病（CVD）差异。如今，非裔美国人死于心脏病的可能性比白人高30%，中风的可能性是白人的两倍。这些差异的原因尚未完全明了。改进识别潜在风险因素的方法是减少黑人与白人之间心血管疾病差异的关键第一步。本文将重点关注外部环境中的环境暴露，以及它们如何导致细胞、分子和器官层面的变化，从而增加个人患心血管疾病的风险，并导致人群层面的心血管疾病种族差异。外部环境分为三大领域：自然环境（空气、水、土地）、建筑环境（居住、工作和娱乐场所）和社会环境（社会、人口、经济和政治）。我们将描述自然环境、建筑环境和社会环境中的环境暴露如何“深入皮肤”，通过表观遗传学、泛组学及相关机制影响基因表达，进而增加不良心血管疾病健康结局的风险和人群层面的差异。我们还将研究代谢组学、蛋白质组学、转录组学、基因组学和表观基因组学在理解自然环境、建筑环境和社会环境中的暴露如何导致心血管疾病差异方面的重要作用，这对临床、公共卫生和政策干预具有启示意义。在本综述中，我们将暴露组方法应用于黑人与白人之间的心血管疾病种族差异研究。暴露组是对个体一生中所有暴露情况及其与健康影响关系的一种衡量。暴露组代表了从受孕开始的所有外源性（外部）和内源性（内部）暴露，同时区分、表征和量化病因、中介、调节和同时出现的风险及保护因素及其与疾病的关系。具体而言，它评估化学和非化学环境暴露与心血管疾病发病、进展和结局相关的生物学机制和潜在途径。暴露组是一种很有前景的方法，有助于理解环境、行为、生物学、遗传学和疾病表型之间的复杂关系，这些关系构成了人群层面黑人与白人之间心血管疾病差异的基础。
