Prevalence of coronary heart disease risk factors in an urban black population: the Minnesota Heart Survey, 1985

A pilot study of cardiovascular risk assessment in Afro-Caribbean patients attending an inner city general practice

BACKGROUND

Afro-Caribbean ethnic minorities are at high risk of stroke and the sequelae of hypertension.

OBJECTIVE

To investigate cardiovascular risk factors and Dundee risk rank in Afro-Caribbeans attending one inner city general practice and to find which methods of health promotion patients preferred.

METHODS

We assessed cardiovascular risk including systolic and diastolic blood pressure in 98 patients of Afro-Caribbean origin.

RESULTS

Fifty per cent of the patients had at least two risk factors for cardiovascular disease. Focus groups suggested that the barriers to effective health promotion included lack of risk awareness, cultural and lifestyle influences, time restrictions and language difficulties.

CONCLUSIONS

The small pilot study highlights both the need for and some of the problems of GP-based cardiovascular health promotion in Afro-Caribbeans.

Socioeconomic status and coronary heart disease risk factor trends. The Minnesota Heart Survey

BACKGROUND

Socioeconomic status (SES) indicators including education, income, and occupation are associated with coronary heart disease (CHD) risk factors, morbidity, and mortality. In most industrialized nations, individuals with less education, lower income, and blue collar occupations have the highest CHD rates. It is suggested by some that these differences by SES are increasing even as age-adjusted CHD mortality declines.

METHODS AND RESULTS

The Minnesota Heart Survey includes measurement of CHD risk factors and behaviors in population-based samples of Minneapolis-St. Paul adults aged 25 to 74 years in 1980 to 1982 (N = 3243) and 1985 to 1987 (N = 4538). Education was significantly and inversely related to blood pressure, cigarette smoking, body mass index, and a summary risk score for both men and women. Serum cholesterol was inversely related to education in women but not in men. Education was positively associated with leisure physical activity and health knowledge. Associations with household income were less consistent in magnitude and direction. Risk characteristics improved significantly between the 1980 to 1982 and 1985 to 1987 surveys. These changes were similar across education and household income levels.

CONCLUSIONS

Improvement in CHD risk factors over time unrelated to education or income suggests that population-wide factors such as improved health knowledge, availability of healthy food items, hypertension treatment, and restrictions on cigarette smoking are operating beneficially in all SES groups. Although the SES gradient in risk factors is not increasing, it remains substantial and indicates directions for future prevention efforts.

Antibiotic use in urban whites and blacks: the Minnesota Heart Survey

OBJECTIVE

To assess racial differences in the use of antibiotics, including penicillins, erythromycins, tetracyclines, sulfas, and cephalosporins.

DESIGN

Population-based surveys, conducted from 1985 to 1987.

SETTING

The seven-county metropolitan area of Minneapolis-St. Paul, MN.

PARTICIPANTS

3127 whites (response rate 68 percent) and 1047 blacks (response rate 65 percent), aged 35-74 years.

RESULTS

White women (26 percent of 1625) were more likely to report having taken an antibiotic in the past year than were white men (18 percent of 1502), black women (18 percent of 590), or black men (15 percent of 457). Reported antibiotic usage decreased with increasing age. Black men were more likely than white men to report the use of tetracyclines or sulfas; otherwise, white men reported higher usage prevalences. White women reported higher usage prevalences of all drug classes than black women.

CONCLUSIONS

Significant independent predictors of antibiotic use were younger age, white race, and female gender. Potential explanations for these differences include differences in patient access, physician-prescribing behaviors, or both.

Epidemiological characteristics of subarachnoid hemorrhage in an urban population

Several risk factors for unfavorable outcome from subarachnoid hemorrhage (SAH) have been identified. The prevalence of such risk factors varies among ethnic groups and among men and women. The influence of ethnic background and gender as factors in the outcome after SAH has not been adequately studied and is the focus of the present investigation. Outcome in 145 consecutive patients was dichotomized as good and moderately disabled vs severely disabled, vegetative, and dead. A multiple logistic regression model was used to examine the factors of gender, ethnic group (white and non-white), age, admission neurological grade, pre-existing hypertension, and intravenous drug abuse. Our data reveal that hypertensive, white males, with a history of intravenous drug abuse, have a high risk of unfavorable outcome following SAH. These observations are important for the design and interpretation of future studies relating to SAH.

Type A behavior and its association with cardiovascular disease prevalence in blacks and whites: the Minnesota Heart Survey

Population-based surveys were conducted in 1985 and 1986 to measure the prevalence of coronary heart disease (CHD) history and risk factors in Black and White adults. Type A behavior was measured by the Jenkins Activity Survey (JAS). JAS scores were associated with age (negatively), education (positively), and sex (men greater than women) but were largely unrelated to CHD risk factors. Blacks had significantly lower age- and education-adjusted Type A and component scores than Whites, more so for men than women. Univariate analysis indicated that a history of angina and/or heart attack was positively associated with the Type A score in both Blacks and Whites. Following adjustment for known cardiovascular risk factors, Type A score remained positively and significantly associated with CHD prevalence. These findings are consistent with other cross-sectional studies and suggest that Type A behavior, as measured by the JAS, may increase the risk of CHD in both Blacks and Whites. Follow-up of these cohorts may help to clarify the complex relationship of Type A behavior to the risk of CHD.

Trends in cardiovascular risk factors in an urban black population, 1973-74 to 1985: the Minnesota Heart Survey

Cardiovascular disease mortality rates have fallen dramatically in blacks in the United States. To determine whether this may be due to a decline in cardiovascular risk factors, we compared risk factors in a 1985 urban black population, ages 35 to 69, with those obtained in blacks of the same area in 1973-74. Age-adjusted mean body mass and the prevalence of overweight increased significantly over the 12-year period in both men and women. Mean systolic blood pressures declined significantly in both sexes, diastolic blood pressure declined significantly in men, and the proportion of men and women hypertensives on medication and under control increased. The overall prevalence of cigarette smoking changed very little, but the proportion of heavy smokers decreased significantly in men. No significant changes occurred in resting heart rate. Concurrently with these risk factor trends, age-adjusted heart disease mortality rates in area blacks fell 27% between 1968-73 and 1979-84, and stroke mortality fell 58%. Changing risk factors may be contributing to declining cardiovascular mortality rates in blacks. However, overweight seems to be a worsening problem.