A recent study conducted by the Mount Sinai Health System has found that young Black individuals are more likely to have a potentially life-threatening condition affecting the heart than young Hispanic adults. Published in the Journal of the American College of Cardiology, the findings concluded that young Black adults living in a socially disadvantaged community were found to have a greater risk for early atherosclerosis compared with young Hispanic adults in the same community.
Researchers used data collected from a study known as the FAMILIA trial to determine their results may be indicative of emerging or undiscovered CV factors attributable to atherosclerotic CVD risk among Black individuals.
“This cross-sectional study of adult FAMILIA trial participants is one of the first to report the presence of 3D vascular ultrasound-assessed subclinical atherosclerosis in a young cohort of mainly women, from a socioeconomically disadvantaged community,” Josep Iglesias-Grau, MD, fellow on preventive cardiology at the Montreal Heart Institute, and colleagues wrote. “Subclinical atherosclerosis prevalence and atherosclerotic burden were both higher in the non-Hispanic Black group than in the Hispanic population, despite both groups having similar 10-year Framingham CV risk scores. These findings … suggest that nontraditional or unknown risk factors could potentially work through distinct epigenetic pathways that might explain the earlier and more encroaching progression of subclinical atherosclerosis among the non-Hispanic Black population.”
To better understand the results and implications of this study, let’s first talk about what atherosclerosis is.
What Is Atherosclerosis?
Atherosclerosis is a narrowing of the arteries caused by a buildup of plaque. Arteries are the blood vessels that carry oxygen and nutrients from your heart to the rest of your body.
In a healthy, normally functioning body, the arteries are flexible and elastic. However, over time, the walls in the arteries can harden, which is a condition commonly known as the hardening of the arteries.
In someone with atherosclerosis, this buildup of plaque is made up of fats, cholesterol, and other substances in and on the artery walls. Plaque can cause the arteries to narrow, which can block blood flow. This can also cause the arteries to burst, leading to potentially life-threatening blood clots.
While atherosclerosis is oftentimes considered to be a heart problem, it can affect arteries anywhere in the body, including around the heart, legs, brain, and kidneys. Without treatment, atherosclerosis can lead to heart attack, stroke, or heart failure, among other conditions.
While atherosclerosis is fairly common among older people, the condition is not common in younger adults or adolescents.
About the FAMILIA Trial
The FAMILIA trial is an assessment used by researchers at Mount Sinai to examine the effectiveness of a school-based educational intervention designed to improve knowledge, attitudes, and heart-healthy lifestyle habits in 562 children. The children in this study had an average age of four years and consisted of 51 percent girls, 37 percent Black, and 54 percent Hispanic/Latino participants. All children were from 15 preschools in the Harlem, New York area.
Mean change in knowledge, attitudes, and habits score was approximately 2.2-fold higher at 5 months among children assigned the intervention compared with controls assigned to no intervention.
Researchers examined the carotid and femoral arteries via ultrasound in 436 parents and caregivers of the FAMILIA trial preschoolers, as well as preschool staff to better understand any racial or ethnic differences in the prevalence of early atherosclerosis.
All participants in this part of the study had no history of cardiovascular disease and had an average age of 38 years. The group comprised about 82 percent women, 66 percent Hispanic/Latino, and 34 percent Black participants.
Racial Differences in Atherosclerosis Risk
Age and sex did not differ significantly between racial/ethnic groups, according to the study. However, within this cohort, researchers noted that Black participants were more than three times more likely to be hypertensive and three times more likely to be active smokers when compared with Hispanic/Latino participants. Black participants also had a higher mean body mass index (BMI) and had a higher self-reported intake of fruits and vegetables when compared to Hispanic/Latino participants.
Researchers also observed that there were no differences between groups in self-reported diabetes, fasting glucose, and total cholesterol between Black and Hispanic/Latino participants.
Using a tool known as the Framingham Risk Score, researchers could use this data to accurately estimate the 10-year risk of a participant developing coronary heart disease.
Across the entire group, the average 10-year Framingham risk was 4 percent, with no differences seen by race/ethnicity. However, researchers noted that the prevalence of early atherosclerosis was higher among Black participants when compared with Hispanic participants; about 12.9 percent and 6.6 percent respectively.
After adjustment for 10-year Framingham risk, BMI, fruit and vegetable consumption, physical activity, and employment status, researchers reported that Black participants had a more than threefold greater risk for early subclinical atherosclerosis compared with Hispanic participants and multi-territorial disease, defined as plaque seen in more than one region.
“These results highlighted once again the critical importance of implementing health promotion and targeted CV prevention strategies, such as smoking cessation and blood pressure control,” the researchers wrote. “Efforts in this area should be targeted at the more affected vulnerable communities, where the largest net gains are likely to be made.”
Bottom Line
So, what can you take away from the results of this study, and what does this mean moving forward?
In short, the medical community at large has known for decades now that socioeconomic factors directly contribute to many known health conditions like cardiovascular disease and early death. But, results from studies such as this show time and time again that these risk factors span far beyond socioeconomic influences, and oftentimes involve other factors such as race or ethnicity.
Dr. Valentin Fuster, the director of Mount Sinai Heart, says there are many other risk factors that they still do not fully understand.
“We describe seven risk factors for cardiovascular disease. Two are mechanical — obesity and high blood pressure — two are chemical, high cholesterol, and high glucose, and three are behavioral — smoking, lack of exercise, and poor diet,” Fuster says. “In the Black population, this is magnified, not only because they have more risk factors than Hispanic population, but there is something else in the Black population that makes them have more disease, and we have to investigate what this is.”
He continued, saying that their study was far from over and that the investigation is continuing around the world. Around 12,000 young people in Europe, South America, and in the US are being studied over decades in search of more answers that might lead to better health.
For now, Fuster and medical experts alike say that it’s vital to take action and make the choice to improve one’s health.
“You have to decide if being healthy is important to you, decide if it’s a priority. If you can’t decide, I can give you all the lessons in the world, I will not achieve anything,” he says.
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