Sex differences in high density lipoprotein cholesterol in urban blacks

Obesity and associated coronary heart disease risk factors in a population of low-income African-American and white women: the North Carolina WISEWOMAN project

BACKGROUND

Obesity has been associated with many co-occurring coronary heart disease (CHD) risk factors as well as CHD mortality. These associations have been shown to vary between African-American and white sample populations.

METHODS

The authors examined whether obesity co-occurs with several CHD risk factors (diabetes, hypertension, hypercholesterolemia, low high-density lipoprotein cholesterol (HDL-C)), and estimated the 10-year risk for CHD in the North Carolina WISEWOMAN (Well Integrated Screening and Evaluation for Women Across the Nation) study sample. This sample includes low-income African-American and white women (> or = 50 years of age).

RESULTS

Among white women (n = 1,284), 34% were overweight (BMI = 25.0-29.99 kg/m(2)) and 35% obese (BMI > or = 30 kg/m(2)); among African-American women (n = 754), 28% were overweight and 59% obese. Among obese and nonobese African-American women, the prevalence of three or more co-occurring risk factors was similar (obese = 17.7% (95% confidence interval (CI): 13.9, 21.6) and nonobese = 13.3% (95% CI: 8.7, 17.8)). By contrast, the prevalence among white women was greater among the obese (26.9% (95% CI: 22.9, 31.0)) than the nonobese (13.0% (95% CI: 9.7, 16.2)).

CONCLUSIONS

The differences between and within African-American and white women may be accounted for by the high levels of HDL-C among obese and nonobese African-American women.

Correlates of high-density lipoprotein cholesterol in Black girls and White girls: the NHLBI Growth and Health Study

To determine the correlates of serum high-density lipoprotein cholesterol (HDL-C) in 9- and 10-year-old girls, data were examined from 624 Black girls and 773 White girls. Black girls had, on average, 3.6 mg/dL higher levels than White girls. Each 10-mm increase in sum of skinfolds was associated with a decrease of 1.4 mg/dL; each unit increase in the tricep/suprailiac skinfold ratio was associated with an increase of 2 mg/dL; and each 10% increase in polyunsaturated fat intake was associated with an increase of 3.4 mg/dL. The associations of sedentary activity and sexual maturation with HDL were mediated by differences in adiposity. Interventions to decrease adiposity may be important for the primary prevention of heart disease in women.

Education, race, and high-density lipoprotein cholesterol among US adults

OBJECTIVES

Although educational achievement is positively related to levels of high-density lipoprotein cholesterol (HDL-C) among White adults, there is an inverse association among Blacks. We assessed whether this interaction could be attributed to differences in the relation of education to correlates of HDL-C.

METHODS

Cross-sectional analyses were based on data from 8391 White and 995 Black adults who participated in the Second National Health and Nutrition Examination Survey.

RESULTS

Associations between education and HDL-C levels varied from negative (Black men), to nearly nonexistent (White men and Black women), to positive (White women). Mean HDL-C levels were higher among Blacks than among Whites, but differences varied according to educational achievement. Among adults with less than 9 years of education, mean levels were 6 to 10 mg/dL higher among Blacks, but the radical difference was less than 1 mg/dL among adults with at least 16 years of education. About 20% to 40% of these differences could be accounted for by obesity, alcohol consumption, and other characteristics.

CONCLUSIONS

Because of the implications for coronary heart disease risk, consideration should be given to behavioral characteristics associated with the interaction between race and educational achievement.

The "big three" cardiovascular risk factors among American blacks and Hispanics

Today's chronic diseases require "treatment" by shifting control of the outcome from the provider back to the individual and the environment in which one functions. There is a strong need to consider the individual in the context of ethnicity and culture, which express themselves in the prevalence and magnitude of risk factors, the biological impact of risk factors and expression of disease, and the potential for control of unhealthy behaviors. Educational and screening programs related to the risk factors of cigarette smoking, hypertension, and cholesterol must be structured so that recommended life-style changes are compatible with the individual's cultural values and beliefs.

Survival determinants in black patients with angiographically defined coronary artery disease

Long-term survival of blacks with angiographically defined coronary artery disease was examined in a series of 1233 consecutive patients who underwent cardiac catheterization at a large urban municipal hospital. Vital status information was available at a mean of 86 weeks for the cohort as a whole, and 94 deaths were recorded. As noted in other angiographic series that included blacks, a high proportion of patients in this study had unobstructed coronary arteries (41%), and there was a preponderance of women (56%). Hypertension was present in 82% of the cases, whereas 68% of the sample had left ventricular hypertrophy as revealed by echocardiogram. The cumulative proportion of patients who were surviving at 5 years was 90 +/- 1 (+/- SEM), 79 +/- 4, and 70 +/- 4 for patients with no obstructive lesions, one-vessel disease, and multivessel disease, respectively. The survival rate at 3 years for patients who had undergone bypass surgery (N = 152) was only 82% (+/- 5%). Noninvasive univariate predictors of mortality included male sex, history of myocardial infarction, Q waves on electrocardiogram, exercise duration on treadmill stress testing, and left ventricular hypertrophy. Angiographic predictors included left ventricular end-diastolic pressure, the number of diseased coronary vessels, ejection fraction, and mean pulmonary artery pressure. Regression analysis showed an independent association for all the angiographic variables noted previously as well as for echocardiographically determined left ventricular hypertrophy. Survival rates for blacks with coronary artery disease in this series were considerably lower than those currently reported for whites, particularly for patients who underwent coronary bypass grafting.(ABSTRACT TRUNCATED AT 250 WORDS)

Distribution of lipoproteins and apolipoproteins in young adults The CARDIA Study

While there are many studies of the distribution of coronary heart disease risk factors in children, adolescents, and middle-aged adults, little information is available on this topic in young adults. The Coronary Artery Risk Development in Young Adults Study (CARDIA) examined 4858 men and women who fasted 10 or more hours, were ages 18 to 30, and were representative of black and white residents of four U.S. communities. Compared with white men, black men had higher age-adjusted mean levels of high density lipoprotein cholesterol (HDL-C) (6.7 mg/dl, p less than 0.001) and apolipoprotein A-l (apo A-l) (9.1 mg/dl, p less than 0.001) and lower concentrations of triglycerides (-19.7 mg/dl, p less than 0.001) and apolipoprotein B (apo B) (-3.3 mg/dl, p less than 0.001). Compared with white women, black women displayed higher concentrations of low density lipoprotein cholesterol (LDL-C) (5.7 mg/dl, p less than 0.001), apo A-l (2.6 mg/dl, p = 0.001), and apo B (3.0 mg/dl, p less than 0.001), but lower triglycerides (-5.8 mg/dl, p=0.001). Gender differences were more pronounced among whites: white men displayed lower mean levels of HDL-C and apo A-l (-9.2 and -7.3 mg/dl, p less than 0.001) and higher concentrations of LDL-C, triglycerides, and apo B (5.2 20.3, and 5.3 mg/dl, p less than 0.001) than white women. Attained level of education was significantly associated with a favorable lipoprotein/apolipoprotein profile, particularly among white women. These data indicate substantial variation in the distribution of lipoproteins and apolipoproteins in young adults, which may be important determinants of future coronary disease risk.