Self-Reported Experiences of Discrimination and Cardiovascular Disease

Abstract

Researchers have long speculated that exposure to discrimination may increase cardiovascular disease (CVD) risk but compared to other psychosocial risk factors, large-scale epidemiologic and community based studies examining associations between reports of discrimination and CVD risk have only emerged fairly recently. This review summarizes findings from studies of self-reported experiences of discrimination and CVD risk published between 2011–2013. We document the innovative advances in recent work, the notable heterogeneity in these studies, and the considerable need for additional work with objective clinical endpoints other than blood pressure. Implications for the study of racial disparities in CVD and clinical practice are also discussed.

Perceived Discrimination and Incident Cardiovascular Events

“…Discrimination has been associated with more depressive symptoms (34), poorer mental health (4-6, 17), poorer sleep (35,36), increased adiposity (12)(13)(14)37), higher blood pressure (9)(10)(11), inflammatory biomarkers (15,16), and subclinical CVD (7,8). However, studies of discrimination and CVD risk factors are not unequivocal (2,17). This probably reflects differences in how discrimination is measured, as well as the complex interplay of personal and environmental factors that (23) score (range, 0-6).…”

“…CVD risk factors included resting systolic blood pressure (average of the last 2 of 3 blood pressure measurements obtained after a 5-minute seated rest using an automated oscillometric sphygmomanometer (Dinamap Pro 100; Critikon, Tampa, Florida)), body mass index (weight (kg)/height (m) 2 ), height (in centimeters), total and high-density lipoprotein cholesterol and triglyceride levels (measured from blood specimens obtained after a 12-hour fast using standard assays), low-density lipoprotein cholesterol level (calculated from the Friedewald equation (29)), self-reported use of antihypertensive medication (confirmed by medication review), and diabetes status based on the 2003 American Diabetes Association fasting criteria (30).…”

“…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)(4)(5)(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)(8)(9)(10)(11)(12)(13)(14)(15)(16).…”

“…In a recent review, Lewis et al (2) called for large prospective epidemiologic studies of experiences of discrimination and objectively measured, clinically relevant endpoints, including clinical CVD outcomes, to more clearly examine the relationship between exposure to discrimination and CVD risk. There also is a need to evaluate whether the experience of unfair treatment in general or racial/ethnic discrimination specifically is related to CVD risk.…”

Racismo e Saúde: um corpus crescente de evidência internacional

“…A pesquisa também tem documentado que experiências de discriminação vividas, muitas delas geradas pelo racismo institucional e cultural, constituem estressores psicológicos que provocam uma série de problemas de saúde e de comportamentos de risco para a saúde (Pascoe;Richman, 2009;Mohammed, 2009;Lewis et al, 2014;Lewi, et al, 2015). Pesquisas anteriores evidenciaram uma forte e consistente associação entre discriminação e riscos elevados de transtornos mentais e sofrimentos psíquicos.…”