Perceived Discrimination and Incident Cardiovascular Events

Abstract

Perceived discrimination is positively related to cardiovascular disease (CVD) risk factors; its relationship with incident CVD is unknown. Using data from the Multi-Ethnic Study of Atherosclerosis, a population-based multiethnic cohort study of 6,508 adults aged 45-84 years who were initially free of clinical CVD, we examined lifetime discrimination (experiences of unfair treatment in 6 life domains) and everyday discrimination (frequency of day-to-day occurrences of perceived unfair treatment) in relation to incident CVD. During a median 10.1 years of follow-up (2000-2011), 604 incident events occurred. Persons reporting lifetime discrimination in ≥2 domains (versus none) had increased CVD risk, after adjustment for race/ethnicity and sociodemographic factors, behaviors, and traditional CVD risk factors (hazard ratio (HR) = 1.36, 95% confidence interval (CI): 1.09, 1.70) and after control for chronic stress and depressive symptoms (HR = 1.28, 95% CI: 1.01, 1.60). Reported discrimination in 1 domain was unrelated to CVD (HR = 1.05, 95% CI: 0.86, 1.30). There were no differences by race/ethnicity, age, or sex. In contrast, everyday discrimination interacted with sex (P = 0.03). Stratified models showed increased risk only among men (for each 1-standard deviation increase in score, adjusted HR = 1.14, 95% CI: 1.03, 1.27); controlling for chronic stress and depressive symptoms slightly reduced this association (HR = 1.11, 95% CI: 0.99, 1.25). This study suggests that perceived discrimination is adversely related to CVD risk in middle-aged and older adults. cardiovascular disease; discrimination; race/ethnicity; risk factors Abbreviations: CI, confidence interval; CVD, cardiovascular disease; HR, hazard ratio; MESA, Multi-Ethnic Study of Atherosclerosis.Racial/ethnic disparities in cardiovascular disease (CVD) risk in the United States are well-documented (1) but not clearly understood. Experiences of ethnic discrimination and racism have long been considered to contribute to racial/ethnic disparities in CVD rates (2), but evidence for this is scarce. As several reviews have highlighted (3-6), much of the extant literature on perceived discrimination and racism has focused on mental health consequences; more recently, studies have linked discrimination to physical health outcomes, including several indicators of cardiovascular health and functioning, such as higher prevalence of carotid artery atherosclerosis and coronary artery calcification, higher blood pressure, greater visceral fat and central adiposity, and higher levels of C-reactive protein and E-selectin (7-16).Evidence linking discrimination to CVD risk factors is inconsistent, with positive, null, and conditional associations that vary by race/ethnicity and/or sex being observed (see Lewis et al. (2) and Williams et al. (17) for reviews). Moreover, there is debate in the literature as to whether racial/ ethnic discrimination is more deleterious to health than other forms of discrimination (18). Few studies examining discrimination and CVD risk factors...

Perceived Discrimination and Cardiovascular Outcomes in Older African Americans

“…Second, older individuals reported less discrimination than younger individuals, which is of importance when considering the associations of discrimination and age-related outcomes such as CVD and death. Third, in contrast to findings from a multi-ethnic cohort 8 , we found no independent associations of perceived discrimination with risk of incident CHD, incident stroke or HF hospitalization. Fourth, we did, however, find an unexpected inverse association of perceived everyday discrimination with all-cause mortality that persisted after adjustment for potential confounders.…”

“…The connection between age and perceived discrimination may relate to factors other than age alone. In the JHS, younger participants had higher education 8,20 and income 8,20 than older participants, and may live and work in environments of greater racial and ethnic diversity where exposure to discrimination would be more likely to occur 9,21 and thus be likely to have adverse effects on proximal (vs. distal) health outcomes.…”

“…Perceived discrimination has been shown to play a role in the development of CV risk factors such as hypertension in AA 7 , but the associations with CV outcomes have been less thoroughly examined. A recent report from a multi-ethnic cohort study found a modestly increased risk of CV events in participants reporting discrimination 8 . Whether this association persists in an exclusively AA population requires further examination.…”

“…Whether this association persists in an exclusively AA population requires further examination. A better understanding of the role of discrimination in AA is of particular importance in designing public health prevention efforts, as AA are not only disproportionately affected with CV disease (CVD) compared with other races and ethnicities, but also most likely to report discrimination 8,9 . Furthermore, the way in which racial discrimination may lead to differences in health risks and outcomes may be complex and mediated by psychosocial factors such as poverty and education.…”

Dietary Factors and Cognitive Function in Poor Urban Settings

“…For example, poor perceived neighborhood safety, a plague in many urban environments, is a stressor that is associated with poor self-rated health [82]. Among racial minorities in poor, urban settings, perceived discrimination is another unique stressor that has been associated with increased risk for poor cardiovascular outcomes [83, 84]. In addition to predicting poorer diet directly, the impact of poor diet on cardiovascular and metabolic health may be exacerbated by a stressful environment.…”