Ethnicity and cardiovascular risk factors

Significant variation is evident among different ethnicities regarding the prevalence, awareness, severity, treatment, and complications of major cardiovascular disease (CVD) risk factors. Relative to white Europeans, stroke mortality is almost doubled in South Asians and Afro-Caribbeans; however, when coronary artery disease mortality is considered, it is high in South Asians and low in Afro-Caribbeans. Hypertension is more common, severe, and is associated with higher rates of morbidity and mortality in black people than white people. Diabetes is more prevalent and less controlled in South Asians which leads to a nearly fourfold higher cardiovascular mortality in South Asians than other ethnic groups. Furthermore, South Asians suffer from a highly atherogenic lipid profile. In contrast, black people are generally known for their higher high-density lipoprotein and lower triglyceride levels than white people which seem to play a major role in protecting them from coronary artery disease. For a given waist circumference, Asian, black, and Caucasian people show different levels of intra-abdominal adiposity and CVD risk. Hence, the joint definition from five major organizations in 2009 of the metabolic syndrome set ethnic-specific values of waist circumference to define central obesity. Black Caribbean men have the highest rates of current smoking among all ethnic groups in the United Kingdom while nearly all South Asian and black African women are never-smokers. Varied genetic and lifestyle-related risk factors and their interactions seem to be responsible for the ethnic differences in CVD risk factors. There is a clear need for ethnic-specific guidelines for diagnosis and treatment of major CVD risk factors to maximize the outcomes of preventive strategies.