Risk factors for cardiovascular and cerebrovascular death among African Americans and Hispanics in Los Angeles, California

Objective: To describe the risk factors associated with cardiovascular mort ality in the African American (AA) and Hispanic populations in Los Angeles County in an effort to define causes for the excess mortality seen in AAs. Methods: This was a longitudinal analysis of all-cause, cardiovascular, and cerebrovascular mortality in a large, prospective multiethnic cohort of in dividuals aged 45-74 years. Death rates between AA and Hispanic men and wom en during the six-year period from 1993 to 1998 due to hypertension, cardio myopathy, acute myocardial infarction (AMI), ischemic heart disease, and st roke were compared. Results: There were 1,157 deaths due to cardiovascular disease (CVD) or cerebrovascular disease among the 71,798 eligible members of the cohort included in these analyses. Age-adjusted mortality rates were two to five times higher in AAs as compared with Hispanics (e.g., 373.15 i n AAs for hypertensive disease vs 50.37 in Hispanics). A history of hyperte nsion was the most common significant risk factor for CVD; other risk facto rs significantly associated with CVD mortality included cigarette smoking a nd a past history of diabetes and stroke. Adjusting for these factors did n ot remove the significance of AA ethnicity as a risk factor for CVD mortali ty in either subjects reporting or subjects not reporting hypertension at b aseline. Conclusions: The evidence for both higher relative severity and hi gher incidence of hypertensive disease among AAs, and the consistency of th e effect across gender, suggests that a major determinant of risk may be a gene/environment interaction.