Cardiovascular Disease in Racial and Ethnic Minorities

Cover......Page 1
Cardiovascular Disease in Racial\rand Ethnic Minorities......Page 2
CONTEMPORARY CARDIOLOGY......Page 3
ISBN 1588299813......Page 5
Foreword......Page 8
Preface......Page 10
Acknowledgment......Page 14
Contents......Page 16
Contributors......Page 18
1 Cardiovascular Disease in Racial/Ethnic Minorities: Overview and Perspectives......Page 20
1. Introduction......Page 21
2. Current Concepts of Race and Ethnicity:    Facts and Fallacies......Page 22
3.2 Unmasking Racial/Ethnic Disparities in Cardiovascular Disease: Nutritional, Socioeconomic, Cultural and Healthcare-Related Contributions......Page 24
3.3 Race and Genetics......Page 25
3.4 Race, Genetics, and Cardiovascular Disease......Page 26
3.6 Dyslipidemia in Racial and Ethnic Groups......Page 27
3.7 Novel and Emerging Risk Factors in Racial/Ethnic Groups......Page 28
3.9 Obesity and the Cardiometabolic Syndrome: Impact on Chronic Kidney Disease and CVD......Page 29
3.11 Cardiovascular Imaging in Racial/Ethnic Populations: Implications for the Adequate Application of Cardiovascular Imaging Techniques Guided by Racial and Ethnic Risk......Page 30
3.12 Unique Aspects of Vascular and Cardiac Ultrasound in Racial/Ethnic Groups......Page 31
3.13 Heart Failure in Racial/Ethnic Populations......Page 32
4. Perspectives on CV Morbidity/Mortality in Racial/Ethnic Minorities......Page 33
5. Practical Approaches to Eliminating Disparities......Page 34
7 Future Considerations......Page 36
1 Summary......Page 41
2 Introduction......Page 42
3 Strengths and Limitations of the Existing Epidemiologic Data......Page 43
4 Life Expectancy and Summary Measures ofPopulation Health......Page 44
5 Cardiovascular Risk Factors and Biomarkers......Page 46
5.2 Prevalence and Trends in Measured Risk Factors......Page 49
5.3 Emerging Risk Factors and Biomarkers of Cardiovascular Risk......Page 54
5.4 Markers of Subclinical Cardiovascular Disease......Page 55
6 Cardiovascular Morbidity......Page 58
7 Access to Care and the Quality ofHealth CareDelivered......Page 59
8 Progress Made in the Elimination ofHealth Disparities......Page 60
9 Summary and Conclusions......Page 62
3 Unmasking Racial/Ethnic Disparities inCardiovascular Disease: Nutritional, Socioeconomic, Cultural, and Health-Care-Related Contributions......Page 69
1 Population-Based CVD Burden/Racial and Ethnic Disparities in CVD......Page 70
2 Likely Causes of Population-Based Differences in CVD Burden by Race/Ethnicity......Page 72
2.1 The Role of Genetics in Race/Ethnicity Disparities in CVD......Page 73
2.2 Environmental Effects......Page 74
2.3 Low Birth Weight......Page 77
2.4 Dietary Nutrients and Physiologic Effects upon CVD......Page 78
2.5 Dietary Nutrients, Socioeconomic Status, and Race......Page 79
2.7 Geography and Acculturation......Page 80
3 Socioeconomic Status and Cardiovascular Disease......Page 81
4 Cardiovascular Disease Disparities in Health-Care Settings......Page 82
4.3 Congestive Heart Failure......Page 83
4.5 Proposed Solutions for Reducing/Eliminating CVD Health Disparities in Health-Care Settings......Page 84
5.2 Cultural Competency Defined......Page 86
5.4 Laizze Faire or Fatalistic Attitudes......Page 88
3.1 Summary......Page 89
4 Race and Genetics......Page 98
1 Introduction......Page 99
2 How is Genetic Variation Structured?......Page 100
3 Measure and use of Genetic Ancestry......Page 102
5 Has Natural Selection Shaped Genetic Variation?......Page 104
6 Conclusion......Page 105
5 Race, Genetics and Cardiovascular Disease......Page 109
1 Introduction......Page 110
2 Predisposition......Page 111
3 Screening......Page 112
4 Pathophysiology......Page 113
4.2 Ethnicity-Based Therapies......Page 114
6 Future Directions......Page 115
8 Glossary......Page 116
9 Acknowledgments......Page 117
6 Hypertension and Stroke    in Racial/Ethnic    Groups......Page 119
1 Introduction......Page 120
2 Epidemiology......Page 121
3.2 Obesity and Sympathetic Nervous System......Page 122
3.3 Endothelial Dysfunction......Page 125
5 New Treatment for Hypertension......Page 128
5.2 Hypertension in Asians......Page 129
7.1 Traditional Risk Factors......Page 130
7.4 Treatment of Stroke......Page 131
8 Conclusions......Page 133
7 Dyslipidemia in Racial/Ethnic Groups......Page 135
1 Introduction......Page 136
2 Dyslipidemia and CVD in African-Americans......Page 137
2.2 Total and Low-Density Lipoprotein (LDL) Cholesterol......Page 138
2.4 High-Density Lipoprotein Cholesterol (HDL-C)......Page 139
2.4.1 HDL-Raising as a Therapeutic Target......Page 140
2.4.4 Mechanism of Higher HDL Levels in AA......Page 141
3.1 Management of Hypertriglyceridemia......Page 142
6 Metabolic Syndrome......Page 143
7 Clinical Trials......Page 145
7.2 ARIES......Page 146
8 Hispanic Americans......Page 147
9 South Asians......Page 148
7.1 Summary and Conclusions......Page 149
8 Novel  Emerging Risk Factors in Racial/Ethnic Groups......Page 155
2 Homocysteine......Page 156
3 Lipoprotein(a)......Page 159
4.1 C-Reactive Protein (CRP)......Page 161
4.2 Interleukin-6 (IL-6)......Page 162
5 Conclusions......Page 163
9 Weight Loss Interventions toControlBlood Pressure inanIncreasinglyOverweight, Multi-ethnic Society......Page 167
1 Introduction......Page 168
3 Prevalence of Overweight and Obesity......Page 169
3.3 Race/Ethnicity......Page 170
4 Weight and Blood Pressure......Page 173
4.2 Behavioral Interventions to Accomplish Weight Loss......Page 174
4.4 Effects of Behavioral Weight Loss Interventions on Blood Pressure......Page 175
4.5 Weight Loss as a Means to Prevent Hypertension......Page 177
4.6 Maintenance of Weight Loss......Page 178
5 Effects of Behavioral Weight Loss Interventions inAfrican-Americans......Page 179
5.1 Multi-ethnic Randomized Controlled Trials of Weight Loss Interventions......Page 180
5.2 Targeted, Culturally Adapted Weight Loss Interventions in African-Americans......Page 185
5.3 Church and Faith-Based Targeted, Culturally Adapted Interventions......Page 186
5.4 Possible Reasons for Differences in Weight Loss Among Black and White Women......Page 193
5.4.1 Modifiable Behavioral Differences......Page 194
6 Effects of Behavioral Weight Loss Interventions in Other Racial/Ethnic Minority Populations......Page 195
6.2 Asian Pacific Islanders/Native Hawaiians......Page 196
9.1 Conclusions......Page 202
10 Obesity and the Cardiometabolic Syndrome: Impact on Chronic Kidney Disease and CVD......Page 208
1 Introduction......Page 209
2 Cardiometabolic Syndrome: A Cluster of CVD Risk Factors......Page 210
2.2 The Link Between CMS, T2DM, and ESRD......Page 213
4 Role of Obesity, Insulin Resistance, and Compensatory Hyperinsulinemia......Page 214
6 The Role of Oxidative Stress......Page 216
8 Microalbuminuria......Page 218
11 Atherogenic Dyslipidemia......Page 219
13 Therapy: Influence of Ethnicity and Perspectives......Page 220
14 Conclusion......Page 224
11 Risk Calculation and Clustering Within Racial/EthnicGroups......Page 229
1 Background......Page 230
2 European Comparative Outlook......Page 234
4 Cardiovascular Disease Risk Estimation    in the African-American Population......Page 236
6 Summary......Page 240
12 Cardiovascular Imaging    in Racial/Ethnic Populations:    Implications for the Adequate Application of Cardiovascular Imaging Techniques Guided by Racial/Ethnic Risk Factor Variations......Page 242
1 Introduction......Page 243
2.1 THE MESA TRIAL: Study Design with Respect to Cardiovascular Imaging......Page 244
2.2 The Third National Health and Nutrition Examination Survey (NHANES III): Racial/ethnic Risk Factor Variations as the Reason for Cardiovascular Imaging Differences......Page 245
4.1 Nuclear Stress Imaging -- Pharmacologic and Exercise......Page 246
4.2 Echocardiography -- Transthoracic, Transesophageal, Stress Echocardiography, and Carotid Intima/Media Thickness Assessment......Page 248
4.3 Computed Tomography Cardiac-Gated Electron-Beam Computed Tomography or Multi-detector ECG-Triggered Acquisition CT Scanning for Coronary Calcium Scoring    and Coronary Angiography......Page 249
4.4 Cardiac Magnetic Resonance Imaging0Function    and Delayed Enhancement as well    as Stress Perfusion......Page 251
5.1 Technique Selection......Page 252
5.2 Diagnostic Bias and Prognostication......Page 253
6 Conclusions......Page 254
13 Unique Aspects of Vascular and Cardiac Ultrasound in Racial/Ethnic Groups......Page 259
2 Left Ventricular Hypertrophy......Page 260
3 Systolic And Diastolic Left Ventricular Heart Failure......Page 266
4 Ultrasound Imaging In Infiltrative Disease......Page 269
5.2 Left Ventricular Noncompaction......Page 270
6 Obesity......Page 274
7 Kawasaki Disease......Page 275
8 Future Considerations......Page 277
14 Heart Failure in Racial/Ethnic Groups......Page 281
1 Overview......Page 282
2 Epidemiology and Variance of Heart Failure in Minority Groups......Page 283
3 Theories of Disparate Cardiovascular Care......Page 284
4.1 Beta (      1Arg389) and Alpha (      2cDel322-325) Receptor Polymorphism......Page 286
4.2 Nitric Oxide and NOS3......Page 287
4.3 Aldosterone Synthase (CYP11B2-C344-T)......Page 288
5 Evidence-Based Medical Therapy for Minorities with Heart Failure......Page 289
5.1 Beta-Blockers......Page 290
5.2 Angiotensin-Converting Enzyme Inhibitors (ACE-I)......Page 291
5.5 Isosorbide Dinitrate/Hydralazine Therapy (ISDN/HYD)......Page 292
6 The A-H   e   FT Experience......Page 298
7 Device and Surgical Therapy for Heart Failure......Page 300
8 Conclusion......Page 303
15 Minority Women and Cardiovascular Disease......Page 309
2 Epidemiology of Cardiovascular Disease in Minority Women......Page 311
3.1.1 Obesity and Metabolic Syndrome......Page 312
3.1.2 Hypertension......Page 313
3.1.5 Tobacco......Page 314
3.2.1 High-Sensitivity C-Reactive Protein......Page 315
3.2.4 Race-Specific Risk Factors......Page 316
3.2.6 Aspirin for Primary Prevention......Page 317
4.1 Stress Testing......Page 318
4.2 SPECT Imaging......Page 319
4.3 Stress Echocardiography......Page 320
5 Varied Presentation......Page 321
6.1 Pathology-Endothelial Function......Page 322
6.3 Treatment......Page 323
8.1 Etiology......Page 324
8.2 Management and Response to Different Treatments......Page 325
15.1 Conclusion......Page 326
Subject Index......Page 333