Disparities in Cardiovascular Mortality Between Black and White Adults in the United States, 1999 to 2019

A Proposed Framework to Aid Primary Care Clinicians in Promoting Cardiovascular Health

Healthy lifestyle behaviors play a significant role in promoting cardiovascular health. Primary care clinicians (PCCs) are tasked with promoting cardiovascular health through the assessment of lifestyle behaviors and the use of behavior change counseling. However, PCCs face several barriers including a lack of training in counseling techniques. We propose a framework to guide the development of a patient-centered digital communication bundle that can aid PCCs in helping their patients create and sustain feasible lifestyle changes. Our framework proposes that this digital communication bundle contains the following features: assess and analyze an individual's cardiovascular health status; communicate personalized information in a health-literacy-friendly, visual format; assess behavioral components of change (e.g., motivation) that can inform the PCC's approach in guiding behavior change; provide PCCs with brief, behavior change counseling prompts that are grounded in motivational interviewing; and assess and address potential structural, socioeconomic, and environmental barriers, thereby fostering resilience in patients' lifestyle change efforts. We highlight the available research to support the need for such a tool and its potential ability to guide PCCs while also promoting behavior change in a patient-centered manner.

All-cause mortality due to conduction abnormalities in the United States: Sex, racial, and geographic variations from 1999 to 2022

BACKGROUND

Mortality related to conduction abnormalities in the United States (US) population is not well documented. Population-based stratification approaches can improve public health policies and targeted strategies.

OBJECTIVE

The purpose of this study was to evaluate all-cause mortality related to conduction abnormalities in the US population METHODS: The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database was used to calculate the age-adjusted mortality rate (AAMR) per 100,000 individuals older than 35 years related to conduction abnormalities between 1999 and 2022.

RESULTS

A total of 207,861 deaths were attributed to conduction abnormalities throughout the study period ,with 56,186 of these deaths occurring between 2020 and 2022. All-cause mortality related to conduction abnormalities has increased during the past decade with an exponential growth in 2020-2021 (coronavirus disease 2019 era; annual percent change of 16.6% per year). Although the mortality rates decreased in 2022, they remained elevated compared to 2019-2020. Throughout the past 2 decades, males consistently exhibited higher mortality rates than females, with the rate in 2022 being 1.5 times higher (AAMR 11.4 vs 7.0 per 100,000). Non-Hispanic Black patients experienced a significantly higher mortality rate compared to non-Hispanic White individuals in the study period (AAMR 13.7 vs 8.6 per 100,000 in 2022). In the past 2 decades, mortality has been persistently higher in rural and small- to medium-sized metropolitan areas than in large metropolitan urban areas.

CONCLUSION

Mortality rates related to conduction abnormalities have increased over the past decade, and persistent disparities have been observed. These data suggest that continued innovative outreach approaches and engagement with underrepresented populations remain essential.

Glucagon-Like Peptide 1 Receptor Agonists and the Deepening Health Equity Divide in America

Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) have changed the landscape of diabetes management, obesity treatment, and cardiometabolic health. As a result, GLP-1 utilization has increased significantly over the past few years. However, emerging evidence raises questions about the potential of these medications to widen existing health disparities. Cost, insurance status, and structural racism all are barriers to access, and these barriers hit hardest on underserved communities who are most in need of these drugs. This article discusses potential evidence of disparities in GLP=1 medication access, utilization, and availability, as well as potential solutions and frameworks that can be adopted with hopes of mitigating these disparities.

County-Level Urbanization and Cardiovascular Death in Patients With Cancer

CONTEXT

Cardiovascular death (CVD) is a leading cause of mortality in patients with cancer, with sociodemographic factors such as urbanization influencing outcomes.

OBJECTIVE

To examine the impact of county-level urbanization on CVD mortality in patients with cancer in the United States from 1999 to 2020.

DESIGN

Retrospective cross-sectional analysis using CDC WONDER mortality data.

SETTING

US counties categorized as rural or urban based on the 2013 NCHS Urban-Rural Classification Scheme.

PARTICIPANTS

Patients with cardiovascular disease (ICD-10: I00-I78) and comorbid cancer (ICD-10: C00-C97), spanning all U.S. counties from 1999 to 2020.

MAIN OUTCOME MEASURES

Age-adjusted mortality rates (AAMRs) per 100 000 population and rural-to-urban rate ratios (RRs) with 95% confidence intervals.

RESULTS

The cumulative rural-to-urban RR for CVD in patients with cancer was 1.11 (95% CI: 1.10-1.11), increasing from 1.00 in 1999 to 1.20 in 2020 (β = 0.009, P < .001). Rural AAMRs were higher across demographic groups, including males (12.85 vs 11.62 per 100 000), females (6.08 vs 5.58), Black individuals (9.76 vs 9.64), and White individuals (8.79 vs 7.94). Rural Black populations showed a rising RR from 0.85 in 1999 to 1.04 in 2020 (β = 0.005, P = .01). Hispanic populations exhibited lower rural mortality, with a stable RR (0.93, P = 1.0). The most common CVD cause was ischemic heart disease (53.93% of rural and 55.9% of urban deaths).

CONCLUSIONS

An increasing rural-to-urban disparity in CVD mortality among cancer patients highlights the role of urbanization in health inequities. Interventions targeting rural health care access and socioeconomic disparities are essential to address this growing gap.

Disparities in cardiovascular disease outcomes and economic burdens among minorities in southeastern Virginia

BACKGROUND

Cardiovascular diseases are the leading cause of mortality in the United States, presenting significant public health challenges and financial burdens, particularly in Southeastern Virginia, where African American and Hispanic (AA&H) populations are disproportionately affected.

METHODS

This retrospective observational study analyzed data from 30,855 hospital discharges of AA&H patients across Southeastern Virginia from 2016 to 2020, focusing on individuals aged 18 to 85 with cardiovascular diseases. Utilizing the Virginia Health Information database, we examined demographic information, clinical data, and healthcare utilization patterns through hypothesis tests and regression models to explore associations between these variables and the economic impacts of cardiovascular diseases.

RESULTS

Heart failure and shock (47.2% of discharges) and cardiac arrhythmia and conduction disorders (12.3%) were the most prevalent cardiovascular conditions. Female patients incurred significantly higher charges than males across conditions (7.1% higher in heart failure, p < 0.0001; 8.8% higher in chest pain, p < 0.01). Younger patients (< 65 years) faced 8.5% higher charges for cardiac arrhythmia with procedures (p < 0.0001) and 5.2% higher charges for circulatory disorders (p < 0.05). Year of discharge consistently predicted increasing costs (standardized coefficient 0.816 for acute myocardial infarction, p < 0.0001). The presence of fluid and electrolyte disorders was associated with significantly higher charges across conditions (standardized coefficient 0.042 for heart failure, p < 0.0001; 0.051 for acute myocardial infarction, p < 0.0001).

DISCUSSION

The findings highlight the complex interplay between demographic characteristics and healthcare costs among AA&H populations, underscoring the need for targeted interventions. The significant economic impact observed calls for culturally competent healthcare strategies that can mitigate high costs and improve health outcomes. However, the retrospective, administrative nature of the data limits establishing causality, with potential misclassification of some conditions.

CONCLUSION

This study provides crucial insights into cardiovascular disease management's demographic and economic dimensions among AA&H populations in Southeastern Virginia. By identifying key factors contributing to healthcare disparities, the research supports the development of tailored interventions aimed at reducing the burden of cardiovascular diseases, thereby improving overall health equity and reducing economic strains on the healthcare system.

Real-world analyses of major adverse cardiovascular events and mortality risk after androgen deprivation therapy initiation in black vs. white prostate cancer patients

BACKGROUND

Prostate cancer(PCa) patients treated with androgen deprivation therapy(ADT) may experience major adverse cardiovascular events(MACE) [1]. Racial disparities in PCa incidence and outcomes have been noted. In contrast to older studies, three recent studies found significantly longer overall survival in Black vs. White patients: 2019 meta-analysis of nine phase III trials in men with metastatic castration-resistant PCa(CRPC) (n = 8820) [2]; 2020 registry study in men with metastatic CRPC (n = 1902) [3]; and 2023 study in men with non-metastatic CRPC (n = 12,992) [4]. Our "real-world" data study compared MACE and all-cause mortality risk for Black vs. White PCa patients. Compared to prior studies [1-4], our study encompassed a broader scope and was not exclusive to CRPC patients.

METHODS

Historical, longitudinal patient-level were collected from the Decision Resources Group (DRG, now Clarivate) Real World Evidence repository. The analysis included PCa patients receiving ≥1 ADT 1991-2020. Multivariable regression model accounted for baseline metastasis, BMI (<18.5 vs. ≥18.5 kg/m2), oncology vs. urology setting, antagonist vs. agonist, personal MACE history, tobacco history, baseline prostate-specific antigen (>4 vs. ≤4 ng/mL), race (White vs. Black), statin use, increasing age per year, ethnicity (non-Hispanic vs. Hispanic), increasing ADT exposure per year, diabetes, hypertension, and family MACE history.

RESULTS

MACE risk was higher for White patients than Black (4.0% vs. 2.4% at one year after ADT initiation; 21.0% vs. 13.3% at four years). Mortality risk after ADT initiation was 1.6% and 2.6% at 1 year and 11.7% and 18.1% at 4 years for Black and White patients, respectively.

CONCLUSIONS

Our analysis reveals a unique finding that MACE and all-cause mortality incidence were higher in White vs. Black patients. Black race is associated with lower MACE rates and improved survival for men undergoing ADT treatment. Whether selection bias, underlying biology or other factors are responsible for these differences remains unknown.

Longitudinal Trends in Heart Failure Mortality Linked to Coronary Artery Disease Among Adults 65 years and older

BACKGROUND

Heart failure (HF) in patients with coronary artery disease (CAD) is a leading cause of mortality among older adults in the United States. This study examines trends in HF with CAD-related mortality among adults aged 65 and older.

METHODS

A retrospective analysis was performed using the CDC WONDER database death certificates from 1999 to 2020. Age-adjusted mortality rates (AAMRs), annual percent change (APC), and average annual percentage change (AAPC) were calculated per 100,000 persons, stratified by year, sex, race/ethnicity, and geographical region.

RESULTS

HF associated with CAD led to 1,597,451 deaths among adults > 65, primarily occurring in medical facilities (37.1%). The AAMR for HF with CAD decreased from 241.7 in 1999 to 156.2 in 2020 (AAPC: -2.23, p < 0.001), which was significant from 1999 to 2014. Men had higher AAMRs than women (227.4 vs. 137.1), with women's rates declining more significantly (AAPC: -3.23, p < 0.001). White adults had the highest AAMRs (183.0), while Asians/Pacific Islanders (81.6) recorded the lowest. Geographically, AAMRs varied, from 92.1 in Hawaii to 257.3 in West Virginia, with the Midwest showing the highest mortality (191.0). Nonmetropolitan areas exhibited higher AAMRs than metropolitan areas (202.6 vs. 166.1) CONCLUSION: Our study reveals striking disparities in HF-related mortality among adults aged 65 years and older in the United States. While AAMRs decreased overall from 1999 to 2014, they have reached an inflection point since 2019, indicating rising mortality rates. Persistent inequalities underscore the critical need for targeted public health interventions to address these issues.

Increased prevalence of coronary heart disease among current smokers carrying APOL1 risk variants within the African American population

BACKGROUND

The apolipoprotein L1 (APOL1) G1 and G2 gene variants, highly prevalent among the African American population (rare in other racial groups), are linked to increased risk of kidney disease, sepsis, and potentially coronary heart disease (CHD). Their role in tobacco-related CHD remains unclear.

OBJECTIVE

To investigate the effect of APOL1 risk variants on the association between tobacco smoking and prevalent CHD in African American adults.

METHODS

We conducted a cross-sectional study involving 519 African American adults recruited through the University of California San Francisco Lipid Clinic. Using multivariable logistic regression, we assessed the association between tobacco smoking and CHD, overall and with its most severe subtype, myocardial infarction (MI), among all participants and APOL1 genotype subgroups.

RESULTS

Among participants, 41% were current (14%) or former (27%) smokers, 54% carried APOL1 risk variants (1 or 2 alleles), and 28% had CHD, including 16% having MI. Current smokers with APOL1 risk variants had 3.3 times higher odds of CHD compared to nonsmokers (95% CI: 1.6, 6.8), with the strongest effect observed in those with 2 risk alleles (odds ratio [OR]: 7.3, CI: 1.1, 48.6) and a substantial effect in carriers of a single risk allele (OR: 3.2, CI: 1.5, 7.2). Among non-carriers, current smoking was not significantly associated with CHD (OR: 1.3). A similar trend was observed for MI. Former smoking was associated with CHD (OR: 2.0), independent of APOL1 genotype.

CONCLUSION

African American smokers with APOL1 G1 and/or G2 risk variants may be at greater risk of CHD; this relationship appears to follow an additive model.

Year 1 of Medicare's Accountable Care Organization Realizing Equity, Access, and Community Health Model

Importance

The US Centers for Medicare & Medicaid Services launched the Accountable Care Organization (ACO) Realizing Equity, Access, and Community Health (REACH) payment model in January 2023. In contrast to prior ACO initiatives, such as the Medicare Shared Savings Program (MSSP), ACO REACH includes equity-focused measures and payment adjustments, including an equity plan and financial risk adjustment for ACOs with higher proportions of underserved beneficiaries. However, it is unknown whether these changes have incented participation from organizations that serve beneficiaries from marginalized communities.

Objective

To compare characteristics between participants in ACO REACH with those in MSSP and the broader pool of Medicare beneficiaries, organizations, and clinicians.

Design, Setting, and Participants

This cross-sectional study included all Medicare beneficiaries clinicians, and ACOs enrolled in fee-for-service Medicare, MSSP, and ACO REACH from January 2022 to January 2023.

Exposure

Enrollment in fee-for-service Medicare, MSSP, or ACO REACH.

Main Outcomes and Measures

Beneficiary, clinician, and ACO characteristics.

Results

In 2023, among 35 801 118 beneficiaries in the overall fee-for-service Medicare program, 18 911 213 (52.8%) were female, and 163 706 (0.5%) were American Indian or Alaska Native, 1 251 553 (3.5%) were Asian or Pacific Islander, 2 952 244 (8.2%) were Black, 2 396 771 (6.7%) were Hispanic, 27 642 765 (77.2%) were White, and 1 394 079 (3.9%) were another race (includes individuals who did not identify with a listed race, including those who self-identified as multiracial) or unknown race. A total of 1 958 881 beneficiaries were attributed to ACO REACH, and 11 340 987 were attributed to MSSP. A total of 132 ACOs participated in ACO REACH, while 456 ACOs participated in the MSSP. Compared with Medicare beneficiaries overall, REACH beneficiaries were older (85 years or older: 14.2% vs 10.3%; standardized mean difference [SMD], 0.44) and more often White (80.2% vs 77.2%) and less often Black (5.9% vs 8.2%) or Hispanic (5.8% vs 6.7%) (SMD, 0.24). REACH beneficiaries were slightly less likely to have Medicare entitlement due to disability (15.2% vs 17.6%) or be dually enrolled (15.1% vs 15.8%) (SMD, 0.07). REACH beneficiaries were less likely to be rural (3.9% vs 8.4%; SMD, 0.19) and less likely to reside in highly vulnerable geographic areas based on the Social Vulnerability Index (27.7% vs 29.4%; SMD, 0.08) compared with beneficiaries overall.

Conclusions and Relevance

These findings suggest that, in its first year, ACO REACH did not achieve its goal of enrolling organizations that serve beneficiaries with high levels of social risk. Without broader participation, ACO REACH is unlikely to achieve its goal of reducing health inequities.

Cardiovascular Hospitalizations Among Older Adults in the US and Denmark

Importance

Cardiovascular disease is the leading cause of death in the US. However, it remains unclear how the burden of cardiovascular events in the US compares with that of other high-income countries with distinct health care systems like Denmark, both overall and by income.

Objective

To compare cardiovascular hospitalization rates (acute myocardial infarction [MI], heart failure [HF], ischemic stroke) and associated outcomes among adults 65 years or older, overall and by income, between the US and Denmark.

Design, Setting, and Participants

This population-based cross-sectional study used national data from the US and Denmark from January 1, 2021, to January 1, 2022. The study population included all Medicare beneficiaries 65 years or older in the US and all adults 65 years or older in Denmark.

Main Outcomes and Measures

The primary outcome was age- and sex-standardized hospitalization rates for MI, HF, and ischemic stroke, as well as 30-day all-cause mortality rates.

Results

The US study population included 58 614 110 adults 65 years or older (mean [SE] age, 74.6 [7.7] years; 32 179 146 female [54.9%]) of whom 1 171 058 (2.0%) were hospitalized for a cardiovascular event. The Danish study population included 1 176 542 adults 65 years or older (mean [SE] age, 75.3 [7.1] years; 634 217 female [53.9%]) of whom 16 305 (1.4%) were hospitalized with a cardiovascular event. The overall age- and sex-standardized cardiovascular hospitalization rate was significantly higher in the US compared with Denmark (risk ratio [RR], 1.50; 95% CI, 1.47-1.52), as were associated 30-day all-cause mortality rates (RR, 1.12; 95% CI, 1.06-1.17). Across conditions, the risk of hospitalization for MI (RR, 1.56; 95% CI, 1.51-1.61) and HF (RR, 2.37; 95% CI, 2.31-2.43) was significantly higher in the US compared with Denmark, whereas hospitalizations for ischemic stroke were lower (RR, 0.90; 95% CI, 0.88-0.93). Overall cardiovascular hospitalization rates in the US were more than 2-fold higher among low-income adults compared with higher-income adults (RR, 2.38; 95% CI, 2.25-2.47), whereas the magnitude of income-based disparities was smaller in Denmark (RR, 1.45; 95% CI, 1.39-1.50).

Conclusions and Relevance

In this international cross-sectional study, cardiovascular hospitalization rates were significantly higher in the US compared with Denmark. There were income-based differences in the burden of cardiovascular hospitalizations in both countries, although the magnitude of these disparities was much greater in the US.

Income, education, and the clustering of risk in cardiovascular disease in the US, 1999-2018: an observational study

Background

Health metrics in the United States (US) have lagged behind other high-income countries in recent decades, and show persistent gaps between socio-demographic groups. Top 20% income earners and college graduates have also increasingly diverged from the reminder of the population in various dimensions over the past few decades. This study described population patterns in cardiovascular diseases (CVD) by income and education over a twenty-year period.

Methods

This analysis used nationally representative data from 10 cycles (1999-2018) of the National Health and Nutrition Examination Survey (NHANES). Participants were stratified by income and education into four groups: top 20% income earners, college graduates; top 20% income earners, non-college graduates; bottom 80% income earners, college graduates; and bottom 80% income earners, non-college graduates. For income, we created a binary variable (ratio > 5 cutoff) using NHANES income-to-poverty ratio variable to create a standardized measure of income. We calculated the age-standardized prevalence and odds ratios of four conditions: congestive heart failure (CHF), angina, heart attack, and stroke, for each income-education group.

Findings

49,704 participants reported data for both income and education. The age-standardized prevalence of CVD outcomes varied across the four groups. This was most significant when comparing the prevalence among the top 20% income, college graduate group to the bottom 80% income, non-college graduate group: CHF (0.5% vs. 3.0%), angina (1.4% vs. 2.8%), heart attack (1.7% vs. 3.9%), and stroke (1.1% vs. 3.4%). Compared to the top 20% income, college graduate group, the odds of all CVD conditions were significantly higher in the bottom 80% income groups (college graduates: odds ratios (ORs) 1.48-3.67; non-college graduates: ORs 2.36-6.52), as well as for CHF and heart attack in the top 20% income, non-college graduates (OR 3.11 [95% CI: 1.92, 5.06] and OR 1.92 [95% CI: 1.35, 2.73], respectively).

Interpretation

Health gaps extend beyond extremes, with risk clustering favoring top 20% income earners with college degrees while most Americans are left behind. Future research should include longitudinal studies that focus on the mechanisms through which both income and education intersect to shape CVD outcomes in the US.

Funding

The Rockefeller Foundation.

Racial and Ethnic Differences in Long-Term Cardiovascular Mortality Among Women and Men From the CAC Consortium

BACKGROUND

Despite an increasingly diverse population, knowledge regarding racial and ethnic disparities is limited among women and men undergoing atherosclerotic cardiovascular (ASCVD) risk assessment.

OBJECTIVES

The aim of this study was to compare cardiovascular (CV) mortality by ASCVD risk and coronary artery calcium (CAC) scores among Black and Hispanic women and men compared with other participants.

METHODS

From the CAC Consortium, 42,964 participants with self-reported race and ethnicity were followed for a median of 11.7 years. Multivariable Cox proportional hazards regression models were used to estimate CV mortality, with separate analyses by sex.

RESULTS

One-third of enrollees were women; 977 self-reported as Black, 1,349 as Hispanic, 1,621 as Asian, and 740 as American Indian/Native Alaskan/Hawaiian or unspecified; the remainder were White. Black women and men had higher ASCVD risk and CAC scores yielding the highest CV mortality compared with other participants. Among Black women and men with a 0 CAC or ASCVD risk score <5%, HRs were 6- to 9-fold higher than that of other women and men. In men with CAC scores ≥100, Black men (HR: 4.2; P < 0.001) had the highest CV mortality compared to all other men. A similar high-risk pattern was noted for Black women with CAC scores ≥100 (P < 0.001), even with adjustment for the ASCVD risk score. Overall, Hispanics had an intermediate CV mortality, less than that of Black participants. This was notable for Hispanic men with a CAC score of 0 (HR: 3.6; P = 0.006) and CAC ≥100 (HR: 2.3; P = 0.03).

CONCLUSIONS

The disproportionately high and excess CV mortality among Black women and men represents significant barriers to reducing the burden of ASCVD through effective risk assessment using ASCVD risk and CAC scores.

Effect of Early Life Trauma Exposure on Vascular Dysfunction in Black Men and Women

BACKGROUND

Psychosocial stressors such as childhood trauma have been associated with an increased risk of hypertension. The impact of childhood trauma on vascular dysfunction in Black adults remains less clear. We examined the association between childhood trauma and vascular function in Black adults.

METHODS AND RESULTS

Childhood trauma exposure and vascular function were assessed in a cohort of healthy Black participants without known cardiovascular disease (n=404) from a large metropolitan city. Childhood trauma was assessed using the Early Trauma Inventory Short Form with higher scores indicative of higher traumatic life events assessed before age 18 years. Outcomes of central augmentation index (CAIx) and carotid femoral pulse wave velocity were measured as indices of wave reflections and arterial stiffness using applanation tonometry (Sphygmocor Inc.), and central pulse pressure (CPP) was calculated as the difference between the central aortic systolic and diastolic blood pressures. Relationships between Early Trauma Inventory Short Form and outcomes were assessed using multivariate-adjusted and sex-stratified linear regression models. The mean age of the cohort was 53 (SD=10.3), 61% women. Cumulative childhood trauma was not associated with CAIx, central pulse pressure, or carotid femoral pulse wave velocity in the minimal or fully adjusted models for sociodemographic, sex, clinical factors, medical history, health behaviors, and depression. Significant trauma × sex interactions were identified for CAIx (P=0.003) and central pulse pressure (P=0.025). Childhood trauma was associated with lower CAIx (β=-0.55% [95% CI, -1.07 to -0.03] in men, but higher CAIx (β=0.35% [95% CI, 0.08-0.63]) and central pulse pressure (β=0.23 mm Hg [95% CI, 0.01-0.43]) in women.

CONCLUSIONS

Childhood trauma is independently associated with impaired arterial compliance in Black women.

Burden of Hyperlipidemia, Cardiovascular Mortality, and COVID-19: A Retrospective-Cohort Analysis of US Data

BACKGROUND

Hyperlipidemia is a major cardiovascular disease (CVD) risk factor, but there are limited data on its mortality trends in CVD over time. We assessed annual hyperlipidemia-related CVD mortality trends in the United States, including the COVID-19 pandemic's impact.

METHODS AND RESULTS

Mortality data were obtained from the Centers for Disease Control and Prevention repository between 1999 and 2020 among patients ≥15 years old, using International Classification of Diseases, Tenth Revision (ICD-10) codes for hyperlipidemia (E78.0-E78.5) and CVD (I00-I99). Age-adjusted mortality rates (AAMRs) per 1 000 000 population were standardized to the 2000 US population. Log-linear regression models were used to evaluate mortality shifts. Average annual percentage change from 1999 to 2019 was used to project 2020 AAMRs, estimating pandemic-attributed excess deaths. From 1999 to 2020, 483 155 hyperlipidemia-related CVD deaths occurred. Despite a general CVD mortality decline, hyperlipidemia-related CVD AAMRs rose from 36.33 in 1999 to 99.77 in 2019. Ischemic heart diseases (AAMR 49.39) were the leading cause, whereas hypertension had the highest mortality increase (average annual percentage change +10.23%). Mortality rates were higher in men (AAMR 104.87) and non-Hispanic (AAMR 82.49), and rural populations (AAMR 89.98). Highest mortality was observed in Black populations (AAMR 84.35), those ≥75 years old (AAMR 646.45), and Western US regions (AAMR 96.88). During the first pandemic year, deaths exceeded projections by 10.55%, with notable increases among ages 35 to 75 (14.23%), Hispanic (17.96%), Black (14.82%), and urban (11.68%) groups.

CONCLUSIONS

Hyperlipidemia-related CVD mortality has risen over the past 2 decades, further heightened by the COVID-19 pandemic, with higher impact on men, Black Americans, the older population, and rural residents. Further study is needed to understand contributing factors and mitigate disparities.

Demographic Differences in Mortality in the District of Columbia

Importance

Washington, District of Colombia (DC), has the largest gap in life expectancy between Black and White populations among major US cities.

Objective

To investigate mortality, key modifiable cardiovascular disease (CVD) risk factors, and temporal trends for non-Hispanic Black and non-Hispanic White populations in Washington, DC, from 2000 to 2020.

Design, Setting, and Participants

This cross-sectional study analyzed the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database for mortality and the Behavioral Risk Factor Surveillance System for the prevalence of risk factors (obesity, hypertension, diabetes, smoking, and hypercholesterolemia) among Black and White populations in Washington, DC, from 2000 to 2020. All analyses were conducted in January 2024.

Main Outcomes and Measures

All-cause and cause-specific, age-adjusted mortality rates per 100 000 person-years, prevalence of risk factors, and corresponding rate ratios (RRs) and 95% CIs comparing Black individuals to White individuals were assessed. Average annual percentage change (AAPC) was examined using joinpoint regression.

Results

Among 102 710 deaths in Washington, DC (51 712 among males [50.3%], 26 100 among individuals aged ≥85 years [25.4%]; 82 308 among Black [80.1%] and 20 402 among White [19.9%] individuals), CVD (33 254 deaths [32.4%]) and cancer (22 677 deaths [22.1%]) accounted for more than half of deaths. All-cause mortality declined between 2000 and 2012 (AAPC, -2.6%; 95% CI, -4.5% to -1.9%), stagnated between 2012 and 2018, and increased between 2018 and 2020 (AAPC, 10.9%; 95% CI. 3.8% to 15.1%). CVD mortality declined between 2000 and 2011 (AAPC, -3.1%; 95% CI, -4.3% to -2.4%) and plateaued thereafter in the Black population, contrasting with the monotonic decline in the White population from 2000 to 2020 (AAPC, -4.7%; 95% CI, -5.3% to -4.1%), for a magnification of disparities from 2000 (RR, 1.5; 95% CI, 1.4 to 1.7) to 2020 (RR, 2.9; 95% CI, 2.5 to 3.3). Cancer mortality decreased from 2000 to 2020 but with a greater magnitude in the White (AAPC, -3.4%; 95% CI, -3.9% to -2.9%) than Black (AAPC, -1.8%; 95% CI, -2.2% to -1.4%) population (RR for 2000, 1.6; 95% CI, 1.4 to 1.8 and RR for 2020, 2.1; 95% CI, 1.8 to 2.4). Risk factors were consistently more prevalent in the Black than White population (eg, hypertension: RR, 2.2; 95% CI, 1.8 to 2.7 in 2001 and 2.3; 95% CI, 1.9-2.6 in 2019). Disparities as assessed by RRs increased for smoking (AAPC, 4.3%; 95% CI, 3.8% to 5.6%), decreased for obesity (AAPC, -1.2%; 95% CI, -1.9% to -0.4%), and remained constant for diabetes, hypercholesterolemia, and hypertension.

Conclusions and Relevance

In this study, all-cause, age-adjusted mortality was higher in the Black than White population, racial disparities worsened for CVD and cancer, and CVD risk factors were more prevalent in the Black population, underscoring the urgent need for precision public health interventions tailored toward high-risk populations.

Procedural Complications and Inpatient Outcomes of Leadless Pacemaker Implantations in Rural Versus Urban Hospitals in the United States

BACKGROUND

Disparities in invasive cardiovascular care and outcomes in rural and urban hospitals across the United States have been reported. However, studies investigating disparities regarding leadless pacemaker outcomes and complications based on hospital location are lacking.

OBJECTIVE

To evaluate differences in outcomes and complications related to leadless pacemaker implantations among rural and urban hospitals.

METHODS

The National Inpatient Sample was used to identify patients who underwent leadless pacemaker implantations in the United States from 2016 to 2020. Study endpoints assessed included procedural complications and inpatient outcomes of leadless pacemaker implantations among rural and urban hospitals.

RESULTS

From 2016 to 2020, there were a total of 28 340 and 665 leadless pacemaker implantations in urban and rural hospitals, respectively. Baseline characteristics were similar among both groups, with notable exceptions of higher rates of coagulopathies (13.2% vs. 6.8%, p < 0.001) and peripheral vascular disorders (10.4% vs. 4.5%, p < 0.001) among urban patients. After multivariable adjustment for confounding variables, leadless pacemaker placements occurring in rural hospitals had lower odds of major complications (aOR 0.59, 95% CI 0.41-0.86), but increased odds of inpatient mortality (aOR 1.70, 95% CI 1.21-2.40). Overall, rural leadless pacemaker recipients experienced lower rates of discharge to home, as well as lower costs and length of stay.

CONCLUSIONS

A majority of leadless pacemaker implantations occurred in urban hospitals in the United States. Important differences in outcomes were described based on urban and rural hospital location. Further investigation and policy changes are encouraged to promote improved cardiovascular care and outcomes in rural residents.

Planetary Health Diet Index in relation to mortality in a prospective cohort study of United States Black females

BACKGROUND

To improve both human health and the health of our planet, the EAT-Lancet Commission proposed the planetary health diet (PHD).

OBJECTIVES

We aimed to evaluate associations of PHD with all-cause, cardiovascular disease (CVD), and cancer-specific mortality among United States Black females.

METHODS

The Black Women's Health Study is a prospective study of self-identified United States Black females. In 2001, 33,824 participants free of cancer and CVD completed a validated food frequency questionnaire. PHD Index (PHDI) was calculated based on reported consumption of 15 food groups, such as whole grains, nonstarchy vegetables, legumes, soy foods, added fat and trans fat, and red/processed meats. Deaths were identified through linkage to the National Death Index. Cox proportional hazards regression, stratified by age and adjusted for smoking status, body mass index, and other CVD risk factors, was used to calculate hazard ratios (HRs) for quintiles of PHDI in relation to all-cause, CVD-, and cancer-specific mortality.

RESULTS

During 18 years of follow-up, we identified 3537 deaths, including 779 from CVD and 1625 from cancer. Females in the quintile representing the highest adherence to PHD were estimated to have an 18% reduction in risk of all-cause mortality [HR = 0.82, 95% confidence interval (CI): 0.71, 0.94] and 26% reduction in CVD-specific mortality (HR = 0.74, 95% CI: 0.55, 0.98), compared with those in the lowest quintile, with similar reductions observed for quintiles 2, 3, and 4. Among individuals under age 55, there was a significant trend of lower CVD mortality risk with a higher level of adherence to PHD (Ptrend = 0.004), and the HR for the highest compared with the lowest quintile was 0.43 (95% CI: 0.21, 0.87). PHDI was not associated with cancer-specific mortality.

CONCLUSIONS

Adherence to a diet that has been shown to benefit the planet was associated with a lower risk of mortality among Black females, primarily driven by a reduction in CVD-specific mortality risk.

2025 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

BACKGROUND

The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2025 AHA Statistical Update is the product of a full year's worth of effort in 2024 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. This year's edition includes a continued focus on health equity across several key domains and enhanced global data that reflect improved methods and incorporation of ≈3000 new data sources since last year's Statistical Update.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Moderating effect of coping strategies on the association between perceived discrimination and blood pressure outcomes among young Black mothers in the InterGEN study

Research suggests experiences of racial discrimination influence blood pressure outcomes among Black women, but little is known about how coping strategies may influence this relationship. Our study aimed to assess the moderating effects of coping strategies on perceived racial discrimination and blood pressure among young Black mothers. We conducted a secondary analysis on data from the Intergenerational Impact of Genetic and Psychological Factors on Blood Pressure study. Eligible participants were African American or Black women aged 21 and older, who did not present with any cognitive disorder that may obscure reporting data, and who had a biological child who was 3-5 years old at the time of study enrollment. In our analysis, systolic and diastolic blood pressure were the primary outcomes, and experiences of discrimination situations and frequency subscales were the primary predictors. We considered the three subscales of the Coping Strategy Indicator (problem-solving, seeking social support, and avoidance) as moderators. Linear regression models were used. Of the 246 female participants (mean age: 31.3 years; SD = 5.8), the mean systolic and diastolic blood pressures were 114 mmHg (SD = 13.8) and 73 mmHg (SD = 10.9), respectively. The frequency of experiences of perceived racial discrimination was significantly associated with higher systolic blood pressure, but this relationship was moderated among participants with greater seeking social support scores (p = 0.01). There were no significant moderation effects in models with diastolic blood pressure as the outcome. Future studies should examine this relationship longitudinally and further investigate specific coping strategies Black women use to manage perceived racial discrimination.

Costs and Healthcare Utilization of Heart Disease by COVID-19 Diagnosis and Race and Ethnicity

Introduction

Heart disease poses a significant health and economic burden in the U.S., with considerable variations in outcomes across different racial and ethnic groups. The COVID-19 pandemic has further highlighted the disparities in healthcare utilization and costs associated with heart disease.

Methods

The authors used the 2021 Merative MarketScan Medicaid claims database to estimate the medical costs and healthcare utilization associated with heart disease by racial and ethnic groups and COVID-19 diagnosis status. This study focused on individuals aged ≥18 years continuously enrolled in a noncapitated insurance plan in 2021. The outcome measures included total medical expenditures and healthcare utilization, including the numbers of emergency department visits and inpatient admissions and length of inpatient stay. The authors employed a generalized linear model with a family of gamma and log links for medical costs, and a negative binomial regression was used for healthcare utilization. Three-way interactions of heart disease, COVID-19 diagnosis, and race and ethnicity categories were implemented after adjusting for age, sex, and comorbidities. The authors reported average marginal effects with 95% CIs.

Results

Among 1,008,166 Medicaid beneficiaries, 8% had heart disease in 2021. The cost associated with heart disease was $10,819 per beneficiary in 2021 (95% CI=10,292; 11,347; p<0.001). The cost was $15,840 (95% CI=14,389; 17,291; p<0.001) for non-Hispanic Black individuals; $9,945 (95% CI=9,172; 10,718; p<0.001) for non-Hispanic White; and $8,511 (95% CI=7,490; 9,531; p<0.001) for Hispanic individuals. Individuals with a COVID-19 diagnosis ($19,638) had $9,541 (95% CI=7,049; 12,032; p<0.001) higher costs associated with heart disease than those without COVID-19 ($10,098) (p<0.001). Individuals with heart disease had higher numbers of emergency department visits (0.937 per beneficiary, 95% CI=0.913; 0.960), inpatient admissions (0.463 per beneficiary, 95% CI=0.455; 0.471), and average length of stay (2.541 days per admission, 95% CI=2.405; 2.677) than those without heart disease.

Conclusions

The study's findings showed that costs and healthcare utilization associated with heart disease are substantial in all racial and ethnic groups and the highest among non-Hispanic Black individuals. Furthermore, individuals with a COVID-19 diagnosis had approximately 2 times higher costs associated with heart disease than individuals without a COVID-19 diagnosis.

Getting to the Heart of the Matter: Exploring the Intersection of Cardiovascular Disease, Sex and Race and How Exercise, and Gut Microbiota Influence these Relationships

Cardiovascular disease (CVD) is the leading cause of death worldwide, with physical inactivity being a known contributor to the global rates of CVD incidence. CVD incidence, however, is not uniform with recognized sex differences as well and racial and ethnic differences. Furthermore, gut microbiota have been associated with CVD, sex, and race/ethnicity. Researchers have begun to examine the interplay of these complicated yet interrelated topics. This review will present evidence that CVD (risk and development), and gut microbiota are distinct between the sexes and racial/ethnic groups, which appear to be influenced by acculturation, discrimination, stress, and lifestyle factors like exercise. Furthermore, this review will address the beneficial impacts of exercise on the cardiovascular system and will provide recommendations for future research in the field.

Understanding and Promoting Preventive Health Service Use Among Black Men: Community-Driven and Informed Insights

Black men experience high rates of adverse health that can be prevented or mitigated by the regular use of preventive health services. Efforts are urgently needed to promote this type of health service use among Black men. The U.S. Preventive Services Task Force and the Institute of Medicine indicate that such efforts must align with Black men's values, perspectives, and preferences. However, little guidance exists on how to align these efforts for Black men. The present qualitative study was developed to understand factors associated with preventive health service use among Black men and community-informed strategies to promote preventive health service use among these men. An approach rooted in community-based participatory research and ecological theory was used. A core leadership team consisting of five Black men from the area guided the project's development, implementation, and evaluation. The core leadership team conducted 22 interviews with Black men from their communities. Four themes emerged from these interviews: (1) holistic well-being challenges faced by Black men: interaction of mental, physical, and societal forces; (2) the interplay of financial, informational, and gendered barriers/facilitators to using preventative health services among Black men; (3) the importance of shared identity in peer health education about preventive health service use; and (4) the need for community-centered initiatives to improve preventive health service use among Black men that prioritize accessibility and information. Findings of the present study can be used to tailor preventive health service use efforts for Black men. Such efforts have the potential to promote health and mitigate health disparities.

Artificial Intelligence Applications in Cardiac CT Imaging for Ischemic Disease Assessment

Artificial intelligence (AI) has transformed medical imaging by detecting insights and patterns often imperceptible to the human eye, enhancing diagnostic accuracy and efficiency. In cardiovascular imaging, numerous AI models have been developed for cardiac computed tomography (CCT), a primary tool for assessing coronary artery disease (CAD). CCT provides comprehensive, non-invasive assessment, including plaque burden, stenosis severity, and functional assessments such as CT-derived fractional flow reserve (FFRct). Its prognostic value in predicting major adverse cardiovascular events (MACE) has increased the demand for CCT, consequently adding to radiologists' workloads. This review aims to examine AI's role in CCT for ischemic heart disease, highlighting its potential to streamline workflows and improve the efficiency of cardiac care through machine learning and deep learning applications.

Speaking Out: Factors Influencing Black Americans' Engagement in COVID-19 Testing and Research

Black communities in the United States (U.S.) have faced stark inequalities in COVID-19 outcomes. The underrepresentation of Black participants in COVID-19 testing research is detrimental to the understanding of the burden of the disease as well as the impact of risk factors for disease acquisition among Black Americans. Prior scholarship notes that the reluctance to engage in medical research among Black people is, in part, due to the exploitation and abuse this community has seen from the medical field and other social institutions. To better understand the barriers and motivations for COVID-19 testing among Black Americans, this study utilized intersectionality as methodological and theoretical frameworks to examine and investigate the barriers and motivations influencing participation in COVID-19 serosurveys (blood test and interview) among the metro-Atlanta Black communities. From May to October 2021, we took a community-based participatory research approach and conducted 52 semi-structured interviews to uncover different Black communities' feelings and opinions towards COVID-19 testing. Key reasons participants agreed to the blood test include (1) curiosity; (2) health upkeep; (3) family/community/social responsibility; and (4) importance of research. Participants' reasons for rejecting the blood test were (1) unnecessary/no benefit; (2) fear (of the known and unknown); (3) fear of needles and/or blood; and (4) discomfort with test setting/procedure. Our findings show that perspectives on willingness to engagement in testing or to not participate varied across gender and age for Black individuals.

Superwoman schema and arterial stiffness in Black American women: assessing the role of environmental mastery

BACKGROUND

Emerging evidence suggests that the Superwoman Schema (SWS)-the sociocultural representation of Black women as naturally strong, independent, and nurturing-may play an important role in Black women's cardiovascular health; but findings have been relatively mixed. One interesting possibility is that environmental mastery, a sense of control over one's environment, may mitigate negative aspects of SWS.

PURPOSE

We investigated whether mastery moderated the association between SWS and pulse wave velocity (PWV), the gold standard measure of arterial stiffness linked to cardiovascular morbidity and mortality.

METHODS

Participants were N = 368 early middle-aged (30-45 years old) Black women from the southeastern USA who completed the 35-item Giscombé Superwoman Schema Questionnaire and Ryff's 14-item environmental mastery scale. Carotid-femoral PWV was assessed using the SphygmoCor device. Linear regression models examined the main and interactive associations of SWS and mastery on PWV, adjusting for age, education, income, body mass index, smoking status, blood pressure, and antihypertensive medication use.

RESULTS

Analyses revealed a significant overall SWS endorsement by mastery interaction [β = -.11, P = .02], such that SWS was positively associated with higher PWV only when mastery was low. Three SWS dimensions drove this association: SWS strength, SWS suppress emotions, and SWS resistance to vulnerability (all P-values < .05) showing similar patterns to the overall SWS interaction with mastery.

CONCLUSIONS

In Black women, high endorsement of SWS is associated with greater arterial stiffness when environmental mastery is low. Thus, SWS may be more physiologically taxing when one senses less control over their environment.

Associations Among Experiences With Racial Discrimination, Religion/Spirituality, and Cigarette Smoking Among African American Adults: The Jackson Heart Study

BACKGROUND

African American adults exhibit disproportionately high rates of tobacco-related diseases and associated death. Experiences with racial discrimination contribute to health disparities among African Americans, but more research is needed to understand associations between perceived discrimination and tobacco use as well as potential protective factors.

PURPOSE

This study examined associations between perceived racial discrimination and cigarette smoking, as well as religion and spirituality as moderators of any associations.

METHODS

Cross-sectional data were drawn from the Jackson Heart Study, a study of cardiovascular disease risk factors among African American adults in Jackson, MS. Measures included perceived everyday discrimination and major life events discrimination that was attributed to race. Participants also reported religious attendance, prayer, spirituality, and whether they prayed in response to discriminatory experiences. Logistic regression models tested associations between perceived racial discrimination and cigarette smoking status, and interactions between religiosity/spirituality and discrimination in predicting smoking status.

RESULTS

A total of 2,972 participants were included in the analysis (62.7% female, mean age 55.1 years). Thirteen percent reported currently smoking cigarettes. Everyday racial discrimination was associated with a higher likelihood of current smoking (p = .01). The association between lifetime racial discrimination and current smoking status was weaker for those who reported prayer as a reaction compared to those who did not report prayer as a reaction (adjusted odds ratio = 0.32, 95% confidence interval: 0.11 to 0.91) while adjusting for demographics and covariates.

CONCLUSIONS

Stressful experiences with racial discrimination may create risks for health behaviors like smoking. However, prayer may act as a coping strategy to help buffer the effects of racial discrimination on smoking behavior.

Rural-urban disparities in cardiovascular disease mortality vary by poverty level and region

PURPOSE

To examine rural and urban disparities in cardiovascular disease (CVD) death rates by poverty level and region.

METHODS

Using 2021 county-level population and mortality data for CVD deaths listed as the underlying cause among adults aged 35-64 years, we calculated age-standardized CVD death rates and rate ratios (RR) for 4 categories of counties: high-poverty rural, high-poverty urban, low-poverty rural, and low-poverty urban (referent). Results are presented nationally and by US Census region.

FINDINGS

Rural and urban disparities in CVD mortality varied markedly by poverty and region. Nationally, the CVD death rate was highest among high-poverty rural areas (191 deaths per 100,000, RR: 1.76, CI: 1.73-1.78). By region, Southern high-poverty rural areas had the highest CVD death rate (256 deaths per 100,000) and largest disparity relative to low-poverty urban areas (RR: 2.05; CI: 2.01-2.09). In the Midwest and West, CVD death rates among high-poverty areas were higher than low-poverty areas, regardless of rural or urban classification.

CONCLUSIONS

Results reinforce the importance of prioritizing high-poverty rural areas, especially in the South, in efforts to reduce CVD mortality. These efforts may need to consider socioeconomic conditions and region, in addition to rural and urban disparities.

Cardiovascular mortality trends and disparities in U.S. breast cancer patients, 1999-2020: a population-based retrospective study

BACKGROUND

Breast cancer survivors face a higher risk of cardiovascular disease (CVD) compared to non-breast cancer patients, yet contemporary data on CVD-related mortality within this group remains scarce.

OBJECTIVE

To investigate trends and disparities in CVD mortality among breast cancer patients.

METHODS

We queried the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (CDC Wonder) and conducted serial cross-sectional analyses on national death certificate data for CVD mortality in breast cancer patients aged 25 and above from 1999 to 2020. We calculated age-adjusted mortality rates (AAMR) per 100,000 individuals and analyzed trends over time using the Joinpoint Regression Program, with further analyses stratified by age, race, census region, and urbanization level.

RESULTS

A total of 74,733 CVDs with comorbid breast cancer in the United States were identified between 1999 and 2020. The AAMR from CVDs with comorbid breast cancer decreased from 2.57 (95% CI [2.50-2.65]) in 1999 to 1.20 (95% CI [1.15-1.24]) in 2020, with an average annual percent change (AAPC) of - 4.3. The three most common causes of CVDs were ischemic heart disease (47.8%), cerebrovascular disease (17.1%), and hypertensive disease (10.6%). Our analysis revealed a significant decrease in AAMR for all CVD subtypes, except for hypertensive diseases and arrhythmias. The decrease in annual percent change (APC) was more pronounced in individuals aged ≥ 65 years compared to those < 65 years (-4.4, 95%CI [-4.9, -3.9] vs. -2.9, 95%CI [-4.1, -1.7], respectively. Notably, non-Hispanic Blacks consistently exhibited the highest AAMR (1.95, 95%CI [1.90-1.99]), whereas Hispanic or Latina patients had the lowest AAMR (0.75, 95% CI [0.72-0.78]). The AAMR was also higher in rural regions than in urban areas (1.64, 95%CI [1.62-1.67] vs. 1.55, 95%CI [1.53-1.56]).

CONCLUSION

The study highlights a significant decline in CVD mortality among breast cancer patients over two decades, with persistent disparities by race and region. Exceptionally, hypertensive diseases and arrhythmias did not follow this declining trend.

Racial Disparity in Obstructive Sleep Apnea Care and its Impact on Cardiovascular Health

Purpose of Review

Racial disparities in sleep health as well as the diagnosis and treatment of sleep disorders have emerged as a key driver of cardiovascular outcomes. Obstructive sleep apnea (OSA), is characterized by repeated airway obstructions during sleep and is associated with an increased risk of cardiovascular disease. While racial and ethnic minorities have disproportionately high OSA prevalence rates, diagnosis rates remain low. One explanation behind this phenomenon are structural environmental and lifestyle barriers that prevent access to OSA care. Additionally, there remains significantly limited understanding of OSA and its causes and symptoms within communities.

Recent Findings

In general, minorities have poorer sleep health due to systemic and environmental racism, which also causes an increased in conditions such as obesity that increases OSA risk. Disparities also persist within various types of OSA treatment. The most common form of treatment, continuous positive airway pressure (CPAP) has lower adherence among African Americans, as well as those living in areas with low socioeconomic status (SES), primarily minorities. There have been a small number of studies that have shown some initial success of educational campaigns about OSA within minority communities in increasing screenings and diagnoses. Peer based education has been an effective technique, and there is a need for such programs to be expanded.

Summary

Disparities persist, with minority groups having worse sleep health and lower rates of adherence to OSA treatment. Some grassroots, peer-led educational campaigns show promise in increasing adherence. In light of these disparities, there remains a need for the field of sleep medicine to continue addressing the systemic barriers that hinder the timely evaluation and treatment in racial minorities.

PREVENT and Pooled Cohort Equations in Mortality Risk Prediction: National Health and Nutrition Examination Survey

Background

The Predicting Risk of CVD Events (PREVENT) equations were developed to address limitations of the Pooled Cohort Equations (PCEs) in predicting atherosclerotic cardiovascular disease (ASCVD) risk. The comparative effectiveness of the PREVENT equations versus the PCEs in predicting mortality risk remains unknown.

Objectives

The purpose of this study was to compare the risk discrimination value of the PREVENT equations with the PCEs for predicting mortality.

Methods

This retrospective cohort study included individuals aged 40 to 79 years, free of cardiovascular disease, from the National Health and Nutrition Examination Survey (1999-2004). The outcomes of interest were all-cause and cardiovascular mortality. Harrell's C-statistics was used to examine risk discrimination.

Results

In this study, including 4,342 individuals (median age: 50.3 [IQR: 44.3-59.6] years, 51.5% females, and 77.0% non-Hispanic White), the median 10-year ASCVD risk was 4.0% (IQR: 1.5%-9.9%) using the PCEs and 2.4% (IQR: 1.2%-5.3%) using the PREVENT equations. The PREVENT equations generated lower ASCVD risk estimates in 81.0% (79.4%-82.6%) of individuals relative to the PCEs, with the lower estimates disproportionately affecting males (97.7% [96.6%-98.8%]) and Black individuals (89.6% [87.3%-91.8%]). Using a 5.0% risk threshold, PREVENT and PCEs classified 26.7% (∼16.9 million U.S. individuals) and 43.4% (∼27.5 million U.S. individuals), respectively, as having a 10-year ASCVD risk >5%. Among the 10.2% classified as high risk by the PCEs, 96.2% were reclassified to a lower risk by PREVENT. The risk discrimination value for all-cause and cardiovascular mortality was similar using the PREVENT equations and the PCEs.

Conclusions

The PREVENT equations provide similar risk discrimination values for mortality compared to the PCEs but estimate lower 10-year ASCVD risk. Replacing PCEs with the PREVENT equations could reduce statin eligibility in a significant number of individuals.

Trends and Disparities in CAD and AMI in the United States From 2000 to 2020

Background

Coronary artery disease (CAD) and acute myocardial infarction (AMI) still pose a significant burden to the health care system, affecting population subgroups differently.

Objectives

The purpose of the study was to describe age, sex, and racial disparities in mortality rates for CAD and AMI in the United States between 2000 and 2020.

Methods

This was an ecological study with trend analysis of mortality rates using data from the National Centers for Disease Control and Prevention surveillance databases.

Results

Between 2000 and 2020, there was a significant decrease in the age-standardized mortality rates of both CAD (from 249.4 to 118 per 100,000 cases [P < 0.001]) and AMI (from 93.4 to 34.1 per 100,000 cases [P < 0.001]), with deceleration in the decline of mortality rates after 2011. CAD and AMI mortality rates were both significantly higher in males (P < 0.001), the 75+ years age group (P < 0.001), and in non-Hispanic Blacks (NHBs) and non-Hispanic Whites (NHWs) compared to Hispanics (P < 0.001). While CAD mortality rates were higher in NHB compared to NHW (P = 0.037), there was no significant difference in AMI mortality rates between NHB and NHW (P = 0.144). There was also no difference in both CAD and AMI mortality rates between the 25 to 44 years and 45 to 64 years age groups (P = 0.051 and P = 0.072).

Conclusions

While a significant reduction in mortality rates is evident, the notable deceleration in this decline in recent years reflects a plateauing of earlier gains and highlights the need to identify new targets. The persistent disparities in the identified population subgroups necessitate further exploration to inform targeted interventions and policies.

Associations Between the Superwoman Schema, Stress, and Cardiovascular Health Among African-American Women

BACKGROUND

African-American (AA) women are less likely to achieve ideal cardiovascular (CV) health compared with women of other racial/ethnic subgroups, primarily due to structural and psychosocial barriers. A potential psychosocial construct relevant to ideal CV health is the superwoman schema (SWS).

PURPOSE

We explored whether the SWS was associated with perceived stress, CV risk factors, and overall CV health among AA women.

METHODS

This cross-sectional analysis of the FAITH! Heart Health+ Study was conducted among AA women with high cardiometabolic risk. Pearson correlation evaluated associations between SWS and CV risk factors (e.g., stress, hypertension, diabetes, etc.). The 35-item SWS questionnaire includes five domains. Stress was measured by the 8-item Global Perceived Stress Scale (GPSS). CV health was assessed using the American Heart Association Life's Simple 7 (LS7) rubric of health behaviors/biometrics. Data acquisition spanned from February to August 2022.

RESULTS

The 38 women included in the analysis (mean age 54.3 [SD 11.5] years) had a high CV risk factor burden (71.1% hypertension, 76.3% overweight/obesity, 28.9% diabetes, 39.5% hyperlipidemia). Mean GPSS level was 7.7 (SD 5.2), CV health score 6.7 (SD 1.8), and SWS score 60.3 (SD 18.0). Feeling an "obligation to help others" and "obligation to present an image of strength" had strongest correlations with GPSS score among all SWS domains (r = 0.51; p = .002 and r = 0.39; p = .02, respectively). Correlation among the SWS domains and traditional CV risk factors was not statistically significant.

CONCLUSION

Our findings suggest that an obligation to help others and to project an image of strength could be contributing to stress among AA women.

Cardiovascular mortality among patients with diffuse large B-cell lymphoma: a population-based study

We aim to investigate cardiovascular mortality risk among diffuse large B-cell lymphoma (DLBCL) patients and explore cardiovascular mortality trends in the past decades in United States. We extracted data from the Surveillance, Epidemiology, and End Results database for adult patients diagnosed with DLBCL between 1975 and 2019. Standardized mortality ratio, joinpoint regression analysis, and competing risk model were analyzed. Overall, 49,918 patients were enrolled, of whom 4167 (8.3%) cardiovascular deaths were observed, which was 1.22 times the number expected (95%CI, 1.19-1.26). During 1985-2019, the incidence-based cardiovascular mortality rate increased by 0.98% per year (95%CI, 0.58-1.39%), with statistically significant increases in age groups younger than 75 years. The cumulative mortality from cardiovascular disease increased by age but never exceeded that from DLBCL. Older age, male sex, earlier year of diagnosis, lower tumor stage at diagnosis, chemotherapy, radiotherapy, and surgery were all poor prognostic factors for cardiovascular mortality.

Esophageal cancer mortality disparities between Black and White adults in the United States, 1999-2020: insights from CDC-WONDER

BACKGROUND AND AIM

Esophageal cancer significantly contributes to US cancer mortality, with notable racial disparities. This study aims to provide updated esophageal cancer mortality trends among Black and White adults from 1999 to 2020.

METHODS

CDC-WONDER was used to identify Black and White adults in the United States from 1999 to 2020. We calculated age-standardized mortality rates, absolute rate differences, and rate ratios to compare the mortality differences between these populations.

RESULTS

From 1999 to 2020 in the United States, there were 303 267 esophageal cancer deaths, with significant racial disparities. The age-adjusted mortality rate for Black adults fell from 6.52 to 2.62 per 100 000, while for White adults, it declined from 4.19 to 3.97 per 100 000, narrowing the racial mortality gap. Gender-wise, the study showed a decrease in the mortality rate from 3.31 to 2.29 per 100 000 in Black women, but an increase from 1.52 to 1.99 per 100 000 in White women. Among young men, the rate dropped in Black men from 12.82 to 6.26 per 100 000 but rose in White men from 9.90 to 10.57 per 100 000. Regionally, Black adults in the Midwest and South initially had higher mortality rates than Whites, but this gap reduced over time. By 2020, Black men had lower mortality rates across all regions.

CONCLUSIONS

Over the last two decades, age-adjusted esophageal cancer mortality decreased in Black adults but stabilized in White adults, reflecting distinct cancer trends and risk factors. The study highlights the importance of tailored public health strategies for healthcare access and risk factor management.

Epidemiology of Hypertension in Older Adults

The exact definition of hypertension in older adults has changed over the decades, but the benefits of strict blood pressure control across the life span are being increasingly recognized by professional societies and guideline committees. This article discusses the prevalence of hypertension in older adults and describes the associations between hypertension and both clinical and nonclinical morbidity in that population.

A Toolkit to Facilitate the Selection and Measurement of Health Equity Indicators for Cardiovascular Disease

Cardiovascular disease (CVD) is the leading cause of illness and death in the US and is substantially affected by social determinants of health, such as social, economic, and environmental factors. CVD disproportionately affects groups that have been economically and socially marginalized, yet health care and public health professionals often lack tools for collecting and using data to understand and address CVD inequities among their populations of focus. The Health Equity Indicators for Cardiovascular Disease Toolkit (HEI for CVD Toolkit) seeks to address this gap by providing metrics, measurement guidance, and resources to support users collecting, measuring, and analyzing data relevant to their CVD work. The toolkit includes a conceptual framework (a visual model for understanding health inequities in CVD); a comprehensive list of health equity indicators (metrics of inequities that influence CVD prevention, care, and management); guidance in definitions, measures, and data sources; lessons learned and examples of HEI implementation; and other resources to support health equity measurement. To develop this toolkit, we performed literature scans to identify primary topics and themes relevant to addressing inequities in CVD, engaged with subject matter experts in health equity and CVD, and conducted pilot studies to understand the feasibility of gathering and analyzing data on the social determinants of health in various settings. This comprehensive development process resulted in a toolkit that can help users understand the drivers of inequities in their communities or patient populations, assess progress, evaluate intervention outcomes, and guide actions to address CVD disparities.

Post-COVID changes and disparities in cardiovascular mortality rates in the United States

Introduction

The COVID-19 pandemic disrupted healthcare delivery and increased cardiovascular morbidity and mortality. This study assesses whether cardiovascular mortality rates in the US have recovered post-pandemic and examines the equity of this recovery across different populations.

Methods

We analyzed data from the CDC WONDER database, covering US residents' mortality from 2018-2023. We focused on cardiovascular diseases, categorized by ischemic heart disease (IHD), heart failure (HF), hypertensive diseases (HTN), and cerebrovascular disease. Age-adjusted mortality rates were calculated for three periods: pre-COVID (2018-2019), during COVID (2020-2021), and post-COVID (2022-2023), stratified by demographic and geographic variables.

Results

Cardiovascular age-adjusted mortality rates increased by 5.9% during the pandemic but decreased by 3.4% post-pandemic, resulting in a net increase of 2.4% compared to pre-COVID levels. When compared to pre COVID age-adjusted mortality rates, post COVID IHD mortality age-adjusted mortality rates decreased by 5.0%, while cerebrovascular and HTN age-adjusted mortality rates increased by 5.9% and 28.5%, respectively. Men and younger populations showed higher increases in cardiovascular Age-adjusted mortality rates. Geographic disparities were notable, with significant reductions in cardiovascular mortality in the Northeast and increases in states like Arizona and Oregon.

Conclusion

The COVID-19 pandemic led to a surge in cardiovascular mortality, with partial recovery post-pandemic. Significant differences in mortality changes highlight the need for targeted healthcare interventions to address inequities across demographic and geographic groups.

Racial Differences in Palliative Care Use in Heart Failure Decedents

BACKGROUND

Minoritized individuals experience greater heart failure (HF) incidence and mortality rates, yet racial disparities in palliative care (PC) in HF are unknown.

METHODS

This retrospective study used electronic medical records to identify adults who were hospitalized at an academic health system and died due to HF between 2012 and 2018. Using multivariable logistic regression, we examined associations between decedents' characteristics and PC consultations (PCCs).

RESULTS

Of 1987 decedents, 45.8% (n = 911) received PCCs. Black decedents had 60% greater odds of receiving PCCs (OR = 1.60; 95% CI = 1.21-2.11) than whites. Median time from PCC to death was shorter among white than Black decedents (31.2 vs 51.5 days; P = .001). Mean age at death was younger among Black than white decedents (71.3 [14.8] vs 81.8 [12.3]; P < .001) and decedents of "other" races (71.3 [14.8] vs. 80.3 [10.4]; P = .001). Black decedents were more likely than whites to receive inotropes (54.4% vs 42.3%; P < .001) and to be admitted to hospitals (39.5% vs 29.7%; P < .001) and intensive care units in their last month (30.3% vs 18.3%; P < .001).

CONCLUSIONS

Findings suggest greater recognition of palliative-care needs among Black individuals with HF; however, most referrals to PC occur late in the disease trajectory.

Trends and Disparities in Ambulatory Follow-Up After Cardiovascular Hospitalizations : A Retrospective Cohort Study

BACKGROUND

Timely follow-up after cardiovascular hospitalization is recommended to monitor recovery, titrate medications, and coordinate care.

OBJECTIVE

To describe trends and disparities in follow-up after acute myocardial infarction (AMI) and heart failure (HF) hospitalizations.

DESIGN

Retrospective cohort study.

SETTING

Medicare.

PARTICIPANTS

Medicare fee-for-service beneficiaries hospitalized between 2010 and 2019.

MEASUREMENTS

Receipt of a cardiology visit within 30 days of discharge. Multivariable logistic regression models were used to estimate changes over time overall and across 5 sociodemographic characteristics on the basis of known disparities in cardiovascular outcomes.

RESULTS

The cohort included 1 678 088 AMI and 4 245 665 HF hospitalizations. Between 2010 and 2019, the rate of cardiology follow-up increased from 48.3% to 61.4% for AMI hospitalizations and from 35.2% to 48.3% for HF hospitalizations. For both conditions, follow-up rates increased for all subgroups, yet disparities worsened for Hispanic patients with AMI and patients with HF who were Asian, Black, Hispanic, Medicaid dual eligible, and residents of counties with higher levels of social deprivation. By 2019, the largest disparities were between Black and White patients (AMI, 51.9% vs. 59.8%, difference, 7.9 percentage points [pp] [95% CI, 6.8 to 9.0 pp]; HF, 39.8% vs. 48.7%, difference, 8.9 pp [CI, 8.2 to 9.7 pp]) and Medicaid dual-eligible and non-dual-eligible patients (AMI, 52.8% vs. 60.4%, difference, 7.6 pp [CI, 6.9 to 8.4 pp]; HF, 39.7% vs. 49.4%, difference, 9.6 pp [CI, 9.2 to 10.1 pp]). Differences between hospitals explained 7.3 pp [CI, 6.7 to 7.9 pp] of the variation in follow-up for AMI and 7.7 pp [CI, 7.2 to 8.1 pp]) for HF.

LIMITATION

Generalizability to other payers.

CONCLUSION

Equity-informed policy and health system strategies are needed to further reduce gaps in follow-up care for patients with AMI and patients with HF.

PRIMARY FUNDING SOURCE

National Institute on Aging.

Exploring the role of blood pressure in the black-white disparity in cardiovascular disease mortality: a causal mediation analysis

BACKGROUND

Cardiovascular diseases (CVDs) are the leading cause of death in the USA, and high blood pressure is a major risk factor for CVD. Despite the overall declining rates of CVD mortality in the USA in recent years, marked disparities between racial and ethnic groups persist, with black adults having a higher mortality rate than white adults. We investigated the extent to which blood pressure mediated the black-white disparity in CVD mortality.

METHODS

Data came from the Multi-Ethnic Study of Atherosclerosis, a diverse longitudinal cohort. We included 1325 black and 2256 white community-based adults aged 45-80 years free of clinical CVD at baseline and followed for 14 years. We used causal mediation analysis to estimate the effect of race on CVD mortality that was mediated through blood pressure.

RESULTS

Black participants had a higher hazard of dying from CVD compared with white participants (adjusted hazard ratio (HR): 1.28 (95% CI 0.88, 1.88)), though estimates were imprecise. Systolic blood pressure mediated 27% (HR: 1.02, 95% CI 1.00, 1.06) and diastolic blood pressure mediated 55% (HR: 1.07, 95% CI 1.01, 1.10) of the racial disparities in CVD mortality between white and black participants. Mediation effects were present in men but not in women.

CONCLUSIONS

We found that black-white differences in blood pressure partially explain the observed black-white disparity in CVD mortality, particularly among men. Our findings suggest that public health interventions targeting high blood pressure prevention and management could be important strategies for reducing racial disparities in CVD mortality.