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Stanford Report, August 12, 1998

Heart disease risk among minority women: 8/98

Minority women face elevated risk of heart disease

African American and Mexican American women have a higher prevalence of cardiovascular risk factors than white women in the United States, and differences in socioeconomic status do not fully explain that gap, Stanford researchers have found.

Marilyn Winkleby, a senior research scholar with the Stanford Center for Research in Disease Prevention, and her colleagues studied data from the Third National Health and Nutrition Examination Survey in order to evaluate the impact of socioeconomic status ­ measured by education level and family income ­ on differences in cardiovascular risk factors by ethnicity. The study, reported in the July 22/29 issue of The Journal of the American Medical Association, is one of the first to document higher levels of cardiovascular risk factors among black and Mexican American women compared with white women of similar age and socioeconomic standing, Winkleby said.

After adjusting for age and socioeconomic status, the researchers found highly significant differences between white women and black or Mexican American women in the key risk factors of body mass index, blood pressure, diabetes and physical inactivity. They also uncovered large differences in cardiovascular risk factors by socioeconomic status ­ a finding that illustrates the high-risk status of both minority women and white women with low socioeconomic status, they assert.

"Our findings are especially relevant in light of the global rise of cardiovascular disease and other chronic diseases that are influenced by the increasing prevalences of hypertension, cigarette smoking, hypercholesterolemia, obesity, physical inactivity and diabetes. Our work builds on previous studies that have documented disproportionate suffering, disability and premature death from cardiovascular disease among ethnic minority women and those with low socioeconomic status," Winkleby and her co-authors wrote in JAMA.

"Fortunately, cardiovascular risk factors are well established and their occurrence can be largely prevented," they continued. "Unfortunately, cardiovascular disease is not curable, a fact that highlights the critical need for effective primary and secondary preventive efforts to lessen the substantial health disadvantages faced by ethnic minority women and women with low socioeconomic status."

Cardiovascular disease is the leading cause of death among women in the United States, accounting for one-half million deaths and 2.5 million hospitalizations annually. These deaths are linked with the primary risk factors for cardiovascular disease: elevated blood pressure, cigarette smoking, hypercholesterolemia, excess body weight, sedentary life style and diabetes, all of which are substantially influenced by behavioral, social, cultural and economic factors, the researchers said.

While some ethnic variations in cardiovascular disease risk may be genetically based, many others probably are attributable to socioeconomic status, since ethnic minority women in the United States are more likely than white women to be poor, have less education and have less access to health resources, Winkleby's group noted.

The researchers recommended that intervention programs identify high-risk populations, develop strong partnerships with communities and tailor strategies to the language and literacy needs, values and cultures of the populations. The public health challenge, they said, is to identify and understand groups of women with high prevalences of risk factors and disease and then to design effective interventions at the individual and societal levels that will benefit those women.

The study was partially funded by grants from the American Heart Association and the U.S. Public Health Service.SR