Endothelial Dysfunction and Racial Disparities in Mortality and Adverse Cardiovascular Disease Outcomes

Abstract

Background: The contribution of arterial endothelial dysfunction (ED) to increased cardiovascular disease (CVD) risk among Blacks is not known. Hypothesis: We investigated whether peripheral arterial ED explains racial disparity in CVD events. Methods: Data from the Heart Strategies Concentrating on Risk Evaluation (Heart SCORE) study was used. Endothelial dysfunction was assessed by the Framingham reactive hyperemia index (fRHI), measured using pulse amplitude tonometry (PAT). Lower values of fRHI indicate more severe ED. The primary outcome of interest was combined CVD events and all-cause mortality. Results: 1454 individuals (62% female, 40% Black, mean age 59 ± 8 years) had available data on fRHI (mean [SD]: 0.74 [0.46]). Over a mean follow-up period of 8.0 ± 2.4 years (11,186 person-years), 116 events were observed. Black race, male sex, smoking, diabetes, blood pressure, triglycerides, C-reactive protein, and interleukin-6 were inversely correlated with fRHI in univariate models. In an unadjusted Cox regression model, fRHI was associated with 20% lower risk of the primary outcome events (hazard ratio [HR] per 1-SD higher fRHI: 0.80, 95% confidence interval [CI]: 0.66-0.97). However, this association was no longer significant after adjustment for CVD risk factors (HR: 0.90, 95% CI: 0.74-1.11). In an age-and sex-adjusted model, Blacks had 1.68 (95% CI: 1.16-2.43) higher risk of primary outcome compared with Whites. This association was not significantly attenuated by addition of fRHI to the multivariable models. Conclusion: Black race is associated with increased risk of CVD events and mortality independent of its associations with ED, as measured by PAT.

Association between ideal cardiovascular health and markers of subclinical cardiovascular disease

“…Our findings are consistent with other studies, which have similarly found increased CVH to be associated with the decreased burden of subclinical CVD . Despite significant racial differences in prevalence of ideal CVH factors, endothelial function, and markers of subclinical CVD (demonstrated by us and prior reports), we did not find strong evidence for difference in the association between ideal CVH and these outcomes between blacks and whites, consistent with other reports . This study contributes to the developing body of evidence supporting AHAs Life's Simple 7 paradigm of focusing on promotion of overall CVH over a sole focus on single risk factors CVD prevention.…”

“…It is not clear if the trend toward stronger differences for CAC and fRHI seen among whites is real and if the lack of statistical significance in our study is because of limitation in power. Given the known difference in CAC and fRHI between blacks and whites, as well as racial differences in ideal CVH variables and CVD outcomes, these findings would merit further evaluation in larger studies.…”

“…In that study, black participants had 82% lower odds of having ≥5 factors of ideal CVH after adjusting for age, sex, and income levels. Others and we also have previously reported that black individuals, compared to whites, have worse arterial endothelial dysfunction and CVD events, but paradoxically lower prevalence of coronary calcium . Given these findings, we aimed to characterize the association between ideal CVH and markers of subclinical CVD in a population with approximately equal representation of black and white participants.…”

Periodontitis and multiple markers of cardiometabolic risk in the fourth decade: A cohort study

“…Indeed, the prevalence in our study was slightly higher than that observed in a similar age group in the NHANES . Similarly, the mean central retinal venule equivalent (CRVE) in our cohort is consistent with a range of other studies, as was our mean F‐RHI score, and the prevalence of MetS …”

“…The Dunedin 38 Indeed, the prevalence in our study was slightly higher than that observed in a similar age group in the NHANES. 38 Similarly, the mean central retinal venule equivalent (CRVE) in our cohort is consistent with a range of other studies, 5 as was our mean F-RHI score, 8,39 and the prevalence of MetS. 40 The strengths of this study include the use of a birth cohort with a very high retention rate, together with comprehensive objective data on periodontitis at ages 32 and 38, and on cardiometabolic risk markers at age 38.…”