Racial and ethnic disparities in the prevalence and management of cardiovascular risk factors in the United States workforce

OBJECTIVE: To assess racial or ethnic differences in workers with respect to awareness, treatment, and control of hypertension, diabetes, and dyslipidemia, and to identify factors associated with these disparities. METHODS: Analysis of nationally representative data collected from employed persons participating in the National Health and Nutrition Examination Survey 1999 to 2002, with sub-analyses by race and ethnicity. RESULTS: Mexican-American workers are less likely than non-Hispanic whites to be aware of their hypertension (odds ratio [OR] = 0.60; 95% confidence interval [CI] = 0.39-0.94) and less likely to be treated (OR = 0.45; 95% CI = 0.23-0.85); less likely to be aware (OR = 0.56; 95% CI = 0.33-0.93) and treated (OR = 0.33; 95% CI = 0.14-0.78) for dyslipidemia; and more likely to be aware of diabetes (OR = 3.01; 95% CI = 1.14-7.95). Non-Hispanic blacks treated for hypertension are less likely than whites to reach blood pressure goal (OR = 0.47; 95% CI = 0.33-0.66). Having a usual place of care is independently associated with awareness and treatment for hypertension, and treatment for dyslipidemia. CONCLUSION: Understanding cardiovascular health disparities in the workforce can help employers structure appropriate workplace screening and prevention programs.     

Diabetes, hypertension, and dyslipidemia in Mexican Americans and non-Hispanic whites

BACKGROUND: Ethnic disparities in healthcare quality have been documented, but knowledge of differences in cardiovascular risk factor prevalence, awareness, treatment, and control between Mexican Americans and non-Hispanic whites remains incomplete. METHODS: Cross-sectional analysis in 2005 of nationally representative data collected from 2256 Mexican-American and 4624 non-Hispanic white adults aged 20 years and over who participated in the 1999-2002 National Health and Nutrition Examination Survey. RESULTS: Type 2 diabetes is significantly more prevalent in Mexican Americans (13% age and gender adjusted) than in non-Hispanic whites (8%); however, Mexican Americans are more likely to be both diagnosed (77% vs 65%) and treated (63% vs 47%). There is no significant difference in the adjusted prevalence of hypertension, at 28% for non-Hispanic whites compared to 26% for Mexican Americans. Mexican Americans have a slightly lower adjusted prevalence of dyslipidemia, at 31% versus 35%. Awareness of hypertension and dyslipidemia are significantly lower in Mexican Americans (57% vs 71% for hypertension, and 33% vs 56% for dyslipidemia). Treatment rates for hypertension and dyslipidemia are also significantly lower in Mexican Americans (42% vs 61% for hypertension; 14% vs 30% for dyslipidemia). Multivariate logistic regression controlling for age, gender, education, and access to care indicate that Mexican Americans are significantly more likely than non-Hispanic whites to be aware and treated for their diabetes, but significantly less likely to be aware and treated for their hypertension or dyslipidemia. CONCLUSIONS: The significantly higher prevalence of diabetes in Mexican Americans, in contrast to hypertension and dyslipidemia, may sensitize healthcare providers to its detection and treatment. Communicating the importance of hypertension and dyslipidemia is essential for eliminating disparities.     

Beliefs among black and white adults about causes and prevention of cardiovascular disease: the Minnesota Heart Survey

We assessed beliefs about the symptoms, causes, and prevention of cardiovascular disease in population-based surveys of black and white Twin Cities adults in 1985-86. Whites had a generally higher awareness of heart attack symptoms than did blacks; 72% of blacks and 85% of whites mentioned chest pain as a likely symptom. Sixty-five percent of blacks and 76% of whites correctly offered at least one of the three major, modifiable risk factors (smoking, hypertension, and high cholesterol in blood or diet) as likely causes of cardiovascular disease. However, less than 5% of respondents mentioned all three major risk factors. The most frequent response offered as a cause was stress/worry (54% of blacks, 51% of whites). Individuals with higher educational levels generally responded more correctly than those with less education. After accounting for differences in educational level, blacks demonstrated a higher awareness of hypertension as a risk factor, whereas whites were more knowledgeable about smoking and cholesterol. In light of the high percentage of adults still lacking awareness about cardiovascular risk, public education about prevention should continue. Such efforts are broadly desirable but may be most effectively targeted toward minorities and groups with less education, in whom awareness is low and risk of disease is high.     

Dietary patterns are associated with stroke in Chinese adults

We recently featured Chinese dietary patterns that were associated with obesity, hyperglycemia, hypertension, and metabolic syndrome. In this study, we examined the association of those dietary patterns and risk of stroke among 26,276 Chinese adults aged ≥45 y by using data from the 2002 China National Nutrition and Health Survey and explored whether those associations were mediated by obesity, hypertension, hyperglycemia, and other cardiovascular risk factors. The traditional southern Chinese dietary pattern, characterized by high intakes of rice and vegetables and moderate intakes in animal foods, was related to the lowest prevalence of stroke. Compared to the traditional southern dietary pattern, the traditional northern Chinese dietary pattern, characterized by high intakes of refined cereal products, potatoes, and salted vegetables, was associated with an elevated risk of stroke [OR = 1.96 (95% CI = 1.48-2.60); P < 0.0001]. Adjustment for conventional cardiovascular risk factors did not appreciably change the association [multivariate adjusted OR = 1.59 (95%CI = 1.16-2.17); P = 0.004]. The Western dietary pattern characterized by high consumption of beef, fruit, eggs, poultry, and seafood is also associated with an elevated risk of stroke [OR = 2.36 (95%CI = 1.82-3.06); P < 0.0001], but the associations became nonsignificant after adjustment for obesity, hypertension, hyperglycemia, and dyslipidemia. In conclusion, we found that the traditional southern dietary pattern was related to low prevalence of stroke and the traditional northern dietary pattern was associated with an increased stroke risk. The Western dietary patterns also association with high risk of stroke, which was largely mediated by obesity, hypertension, hyperglycemia, and dyslipidemia.     

Implementation of the patient education about cardiovascular risk factors into a daily routine of the Cardiology Unit of the hospital

BACKGROUND: Cardiovascular disease remains the leading cause of death in developed countries. Main modifiable cardiovascular risk factors are smoking, hypertension and dyslipidemia. We sought to introduce the patient education about these risk factors into a daily routine of the Cardiology Unit of the hospital. METHODS: In November 2003, 56 patients filled out the questionnaire at discharge from the Cardiology Unit. Collected data were discussed with the physicians of this unit. In December 2003, 64 patients of this unit once again were asked to fill out the questionnaire. RESULTS: In December, less patients were not informed by physicians about smoking risk (3.1% versus 18.2%, P = 0.03) and diet (0% versus 18%, P = 0.0001), more patients quitted smoking (75% versus 50%, P = 0.03), less patients claimed unaware of their blood pressure (6.25% versus 21.4%, P = 0.01), cholesterol level (3.1% versus 60.7%, P = 0.00001) and the necessity to correct them (0% versus 22.7%, P = 0.0001, and 0% versus 64.3%, P = 0.00001). CONCLUSIONS: Implementation of the patient education about cardiovascular risk factors by physicians into the daily routine of the Cardiology Unit was successful.     

Influenza and pneumococcal vaccination of adults aged > or = 65: racial/ethnic differences

BACKGROUND: Influenza and pneumococcal polysaccharide vaccination (PPV) rates among persons aged > or = 65 years are significantly below national objectives of 90%, particularly among blacks and Hispanics. This study of the 2002-2003 influenza season examines factors that may be associated with low coverage. METHODS: A national sample of 1839 community-dwelling adults aged > or = 65 years was surveyed by telephone during January-May 2003. Outcomes analyzed in 2004-2005 included self-reported influenza vaccination and PPV; place of vaccination; and among the unvaccinated, main reasons for nonvaccination, awareness of vaccination, and receipt of provider recommendation for vaccination. RESULTS: Influenza vaccine coverage was 67.8%, and PPV coverage was 60%. Coverage among blacks and Hispanics was > or = 15 percentage points below that of whites. Half (52%) of persons who had not received PPV were aware it was recommended for persons their age, and < 10% had received a recent physician recommendation for PPV. Concern about side effects and not thinking that they needed the vaccine were the most frequently cited reasons for not receiving an influenza vaccination. In each racial/ethnic group, prevalence of potential missed opportunities (recent doctor visit, but no vaccine recommendation from provider and no influenza vaccination) was higher than prevalence of potential vaccine refusal (recent doctor visit and vaccine recommendation from provider, but no vaccine): blacks, 26.9% versus 7.9%; Hispanics, 19.9% versus 12.1%; and white non-Hispanics, 16.2% versus 6.1%. CONCLUSIONS: Improved adherence to vaccination guidelines by healthcare providers could substantially raise coverage in all racial/ethnic groups. Multiple factors contribute to racial/ethnic disparities, and their relative contributions should be further quantified.     

Racial/ethnic disparities in prevalence, treatment, and control of hypertension--United States, 1999-2002

High blood pressure (HBP) is a major risk factor for heart disease and stroke, end-stage renal disease, and peripheral vascular disease and is a chief contributor to adult disability. Approximately one in four adults in the United States has hypertension. Although effective therapy has been available for more than 50 years, most persons with hypertension do not have their blood pressure (BP) under control. National health objectives for 2010 include reducing the proportion of adults with HBP to 16% (baseline: 28%), increasing the proportion of adults with hypertension who are taking action to control it to 95% (baseline: 82%), and increasing the proportion of adults with controlled BP to 50% (baseline: 18%). During 1990-2000, the prevalence of hypertension, the percentage of those with hypertension who were aware of their condition, and treatment and control of hypertension increased among non-Hispanic whites, non-Hispanic blacks, and Hispanics. CDC analyzed data from the National Health and Nutrition Examination Surveys (NHANES) for 1999-2002. This report summarizes the results of that analysis, which determined that racial/ethnic disparities in awareness of, treatment for, and control of hypertension persist. If national health objectives are to be met, public health efforts must continue to focus on the prevention of HBP and must improve awareness, treatment, and control of hypertension among minority populations.     

Racial differences in the treatment of colorectal cancer: a comparison of surgical and radiation therapy between Whites and Blacks

PURPOSE: To evaluate black to white differences in treatment for colorectal cancer. METHODS: Only whites or blacks diagnosed with colon or rectal cancer between 1988 and 1997 were identified from SEER database. RESULTS: A total of 106,377 (91.3% white, 50.5% male) patients formed the study population. The vast majority of these patients received standard cancer treatment. Although the number of subjects who did not receive such treatment was small, their proportion was higher among blacks than among whites. The odds of non-receipt of surgical treatment was higher among blacks than whites for stage I (OR = 2.08, 95% CI, 1.41, 3.03 among males; OR = 2.38, 95% CI, 1.69, 3.45 among females) and stage IV colon cancer (OR = 1.25, 95% CI, 1.01, 1.56 among males; OR = 1.41; 95% CI, 1.14, 1.72 among females). A similar pattern was also seen for most stages of rectal cancer. CONCLUSIONS: Most black and white colorectal cancer patients received standard treatment. Although the number of subjects without standard treatment was small, their proportion was higher among blacks than among whites. Blacks were also more likely to refuse recommended treatment. Efforts in educating black patients about the benefits of treatment may help to eliminate the remaining racial disparity.     

Are race differences in the prevalence of hypertension explained by body mass and fat distribution? A survey in a biracial population.

Body mass and body fat distribution are important considerations in the study of hypertension. However, few studies have investigated the relationships with regards to race differences in elevated arterial pressure. A population-based sample of black and white adults was assessed by interview and physical measurement. The prevalence of hypertension (defined as 140/90 mmHg and/or medically treated) was disproportionately higher among blacks than whites. In addition, blacks had a higher prevalence of the more severe hypertension (160/95 mmHg) and hypertension with higher prevalence at earlier ages than whites. Black females had a significantly higher distribution of body mass index (BMI) than white females, while no difference was found in the distributions of males. White males had a higher distribution of waist to hip ratio (WHR) than black males, while black females had the higher values compared to white females. The prevalence of hypertension increased with BMI and WHR. Blacks maintained higher rates of hypertension after controlling for BMI and WHR, however, the margin of difference diminished when BMI and WHR was considered together. The black-white difference in hypertension was not completely explained by BMI and WHR. In addition, the strength of the association of hypertension and body size was different for blacks and whites which suggests possible differences in the mechanisms regulating blood pressure.     

Prevalence of breast arterial calcifications in an ethnically diverse population of women

PURPOSE: Breast arterial calcifications (BAC) identified on routine mammography have been associated with coronary heart disease (CHD) risk factors including diabetes and hypertension, angiographically defined CHD, and increased cardiovascular mortality. Accumulating evidence suggests that the mammogram may be an important tool to identify women at risk for CHD, however, the epidemiology of BAC has been poorly defined and previous studies limited to white populations. METHODS: The mammograms of 1905 consecutive women (51.2% Hispanic, 25.8% white, 15.3% black, 5.4% other, 2.2% Asian, ages 35-92 years) were evaluated for the presence of BAC and the number of calcified arteries. RESULTS: The overall prevalence of BAC was 29.4% and was significantly higher for Hispanics compared with whites (34.5% vs. 24.0%, p=0.0002) and lower for Asians compared with whites (7.1% vs. 24.0%, p < 0.02). Among BAC-positive women aged 65 years or less, blacks had more calcified arteries than whites (p < 0.01). The presence of BAC increased with age (p for trend < 0.0001). In age-adjusted models, older Hispanics were more likely to be BAC-positive than whites of similar age (p < 0.02). CONCLUSION: These results indicate that BAC varies significantly by age and race/ethnicity. These findings should be taken into consideration when designing future studies of BAC and CHD.     

2004年四川省4县（区）主要慢性病患病及综合防治行为分析

目的了解四川省4县（区）居民主要慢性病的患病状况,为制定相关疾病预防和控制措施提供科学依据。方法在四川省九寨沟县、汉源县、资中县和攀枝花仁和区4个慢病危险因素监测点,采取多阶段分层随机抽样的方法抽取1680名18～69岁居民,采用问卷调查人口学、主要慢病患病及相关危险因素等,体格检查测量身高、体重、血压等。结果四川省4县（区）调查人群年龄在18～69岁,其中男性775（46．24％）,女性901人（53．76％）。高血压患病率为14．56％,标化率为11．62％;血脂异常率为0．54％,标化率为0．43％;糖尿病患病率为0．60％,标化率为0．42％;其他心血管疾病（冠心病、风湿性心脏病等）患病率为1．79％,标化率为1．38％。高血压、血脂异常和糖尿病患者定期监测血压、血脂和血糖的频率较低;大多采用按医嘱服药和控制饮食的方法来控制病情,高血压患者2种措施比例分别为80．70％和28．07％,血脂异常为6人、5人,糖尿病均为80．00％。结论四川省4县（区）高血压患病率略低于全国水平,血脂异常、糖尿病及其他心血管疾病患病率均低于广州、北京等发达地区。慢病患者的综合防治行为较差。高血压和心血管疾病有明显的性别差异。应加强对居民慢性病防治知识的健康教育,使其提高自我保健意识;规范慢性病患者管理;对不同性别高血压等心血管疾病患者进行分类管理。     

Influenza, pneumococcal, and tetanus toxioid vaccination of adults--United States, 1993-7.

PROBLEM/CONDITION: An increasing proportion of adults have received recommended vaccinations against influenza, pneumococcal infection, and tetanus. However, in 1995, fewer than 60% of adults were vaccinated as recommended. REPORTING PERIOD COVERED: 1993-1997. DESCRIPTION OF SYSTEM: Data were obtained from the state-based Behavioral Risk Factor Surveillance System (BRFSS) for 1993, 1995, and 1997 and from the National Health Interview Survey (NHIS) for 1995 to describe national, regional, and state-specific patterns of use of influenza and pneumococcal vaccines and tetanus toxoid among noninstitutionalized adults aged > or = 18 years. RESULTS: Among adults aged > or = 65 years in 1995, 58% reported receiving an influenza vaccination during the previous 12 months, and 34% reported ever receiving a pneumococcal vaccination. In this age group, non-Hispanic whites were more likely to report receipt of influenza (61%) and pneumococcal vaccines (36%) than non-Hispanic blacks (40% and 22%, respectively) and Hispanics (50% and 23%, respectively). Among the 50 states and the District of Columbia, the median vaccination level among older adults (i.e., persons aged > or = 65 years) increased from 51% in 1993 to 66% in 1997 for influenza vaccine, and from 28% in 1993 to 46% in 1997 for pneumococcal vaccine. Adults with chronic medical conditions had low vaccination levels. Those aged 50-64 years were more likely than those aged 18-49 years to report influenza (38% versus 20%) and pneumococcal vaccination (20% versus 12%). In 1995, the proportion of adults who reported receiving a tetanus vaccination during the previous 10 years decreased with age, from 65% among those aged 18-49 years to 54% among those aged 50-64 years and to 40% among those aged > or = 65 years. In each age group, women were less likely than men to report receiving tetanus toxoid; and among adults aged > or = 65 years, Hispanics and Asians/Pacific Islanders were least likely among all racial/ethnic groups to report receiving tetanus toxoid. INTERPRETATION: By 1995, the Healthy People 2000 objective to increase to at least 60% the proportion of persons aged > or = 65 years who had received annual influenza vaccination had been achieved among non-Hispanic whites (objective 20.11). However, substantial improvement is needed among non-Hispanic blacks, Hispanics, and adults aged < 65 years with high-risk medical conditions. PUBLIC HEALTH ACTIONS: Continued surveillance of vaccine coverage among adults will direct attention to undervaccinated populations that may be disproportionately affected by vaccine-preventable diseases. Vaccination coverage data can be used to guide efforts to increase awareness among health-care providers and the public about the benefits of vaccination, establish systems to ensure that every contact with the health-care system is used to update vaccinations, and further support financial mechanisms to increase vaccine delivery.     

Body mass index and obesity-related metabolic disorders in Taiwanese and US whites and blacks: implications for definitions of overweight and obesity for Asians

BACKGROUND: Recommendations based on scanty data have been made to lower the body mass index (BMI; in kg/m(2)) cutoff for obesity in Asians. OBJECTIVE: The goal was to compare relations between BMI and metabolic comorbidity among Asians and US whites and blacks. METHODS: We compared the prevalence rate, sensitivity, specificity, predictive values, and impact fraction of comorbidities at each BMI level and the BMI-comorbidity relations across ethnic groups by using data from the third National Health and Nutrition Examination Survey and the Nutrition and Health Survey in Taiwan (1993-1996). RESULTS: For most BMI values, the prevalences of hypertension, diabetes, and hyperuricemia were higher for Taiwanese than for US whites. In addition, increments of BMI corresponded to higher odds ratios in Taiwanese than in US whites for hypertriglyceridemia (P = 0.01) and hypertension (P = 0.075). BMI-comorbidity relations were stronger in Taiwanese than in US blacks for all comorbidities studied. BMIs of 22.5, 26, and 27.5 were the cutoffs with the highest sum of positive and negative predictive value for Taiwanese, US white, and US black men, respectively. The same order was observed for women. For BMIs >27, >85% of Taiwanese, 66% of whites, and 55% of blacks had at least one of the studied comorbidities. However, a cutoff close to the median of the studied population was often found by maximizing sensitivity and specificity. Reducing BMI from >25 to <25 in persons in the United States could eliminate 13% of the obesity comorbidity studied. The corresponding cutoff in Taiwan is slightly <24. CONCLUSION: These data suggest a possible need to set lower BMI cutoffs for Asians, but where to draw the line is a complex issue.     

Understanding social disparities in hypertension prevalence, awareness, treatment, and control: the role of neighborhood context

The spatial segregation of the US population by socioeconomic position and especially race/ethnicity suggests that the social contexts or "neighborhoods" in which people live may substantially contribute to social disparities in hypertension. The Chicago Community Adult Health Study did face-to-face interviews, including direct measurement of blood pressure, with a representative probability sample of adults in Chicago. These data were used to estimate socioeconomic and racial-ethnic disparities in the prevalence, awareness, treatment, and control of hypertension, and to analyze how these disparities are related to the areas in which people live. Hypertension was significantly negatively associated with neighborhood affluence/gentrification, and adjustments for context eliminated the highly significant disparity between blacks/African-Americans and whites, and reduced the significant educational disparity by 10-15% to borderline statistical significance. Awareness of hypertension was significantly higher in more disadvantaged neighborhoods and in places with higher concentrations of blacks (and lower concentrations of Hispanics and immigrants). Adjustment for context completely eliminated blacks' greater awareness, but slightly accentuated the lesser awareness of Hispanics and the greater levels of awareness among the less educated. There was no consistent evidence of either social disparities in or contextual associations with treatment of hypertension, given awareness. Among those on medication, blacks were only 40-50% as likely as whites to have their hypertension controlled, but context played little or no role in either the level of or disparities in control of hypertension. In sum, residential contexts potentially play a large role in accounting for racial/ethnic and, to a lesser degree, socioeconomic disparities in hypertension prevalence and, in a different way, awareness, but not in treatment or control of diagnosed hypertension.     

Application of the time-series approach to assess the temporal trend of racial disparity in chlamydia prevalence in the US National Job Training Program

The authors applied a time-series approach to assess the temporal trend of racial disparity in chlamydia prevalence between young, socioeconomically disadvantaged blacks and whites entering the US National Job Training Program. Racial disparity was defined as the arithmetic difference between age group-, specimen type-, and region of residence-standardized chlamydia prevalences in blacks and whites. A regression with autoregressive moving average errors model was employed to adjust for serial correlation. Data from 46,849 women (2006-2008) and 136,892 men (2004-2008) were analyzed. Racial disparity significantly decreased among women (by an average of 0.122% per 2-month interval; P < 0.05) but not among men (-0.010%, P = 0.57). Chlamydia prevalence significantly declined for black women (-0.139% per 2-month interval; P = 0.004), black men (-0.045%, P < 0.001), and white men (-0.035%, P = 0.002) but not for white women (-0.028%, P = 0.413). Despite the decreases among black women and black men, the black-white disparities remained high for both sexes; in 2008, the racial disparity was 8.1% (95% confidence interval: 6.8, 9.3) for women and 9.0% (95% confidence interval: 8.4, 9.6) for men. These findings suggest that current chlamydia control efforts may be reaching young black men and women but need to be scaled up or modified to address the excess risk among blacks.     

Menthol cigarette smoking and oesophageal cancer

Oesophageal cancer incidence and mortality among American blacks is over three times the rate for whites. Between 1950 and 1977 the age-adjusted oesophageal cancer mortality rate approximately doubled in non-whites while remaining virtually unchanged in whites. Between World War II and the 1970s menthol cigarette sales dramatically increased, roughly paralleling the increase in oesophageal cancer among blacks. The present study uses existing data from a large hospital-based case-control study to test whether menthol cigarette smoking is related to oesophageal cancer. Oesophageal cancer cases were current smokers. Controls were matched to the cases on age (+/- 5 years) and sex, had conditions thought not to be related to tobacco use, and were also current smokers. Tabular analyses showed no change in risk for males ever-smoking menthol versus those never smoking menthol cigarettes. For women, however, there was an increased risk. Results of logistic regression analyses performed to account for potential confounding factors showed a marginally significant (P = 0.08) decrease in risk among male short term (less than 10 years) menthol smokers versus male never-menthol smokers (OR = 0.50, 95% Cl: 0.23-1.07) but no increased risk for menthol smoking of longer duration. Duration of menthol smoking fitted as a continuous variable showed no increased risk (P = 0.9) after accounting for non-menthol cigarette smoking duration (about 2% per year increase, P = 0.02). For females, the logistic analysis produced a marginally significant (P = 0.07) increased risk for longer menthol use (OR = 2.30, 95% Cl: 0.93-5.72).(ABSTRACT TRUNCATED AT 250 WORDS)     

Comparison of cardiovascular risk factors in obese blacks and whites

Blacks are known to have higher blood pressure levels, a higher prevalence of hypertension, and higher body weights than whites. However, the interrelationships of these and other cardiac risk factors have not been analyzed in an obese population. We compared blood pressure (BP) and lipid levels in 174 obese blacks and 939 obese white patients who were entering a weight loss program; we also assessed the effects of weight loss on these factors. Prevalence of treated hypertension was similar in blacks and whites (28% vs. 25%, respectively). In patients not taking BP medication, black women weighed more (108 kg) than white women (102 kg) and black and white males' weights were similar (135 kg vs. 131 kg). Systolic and diastolic BP were similar in black and white women; black males had similar SBP but a significantly lower DBP than white males (83 mmHg vs. 89 mmHg, respectively). Lipid levels were similar in black and white women except black women had lower triglycerides (1.30 mmol/L) than white women (1.58 mmol/L, p < 0.05); and black males compared to white males had significantly lower total cholesterol (4.76 mmol/L vs. 5.56 mmol/L), LDL-cholesterol (3.15 mmol/L vs. 3.52 mmol/L) and triglycerides (1.31 mmol/L vs. 2.17 mmol/L, p < 0.05). Adult-onset obesity adversely affected a number of cardiovascular risk factors in whites, but not in blacks. Blacks lost significantly less weight (-13 kg) than whites (-19 kg). However, controlling for the difference in weight loss, blacks sustained comparable improvement in lipids and blood pressure, except for TC/HDL-C (whites improved significantly more, -0.36 kg/m2, than blacks, 0.03 kg/m2). Thus, the impact of obesity on cardiovascular risk factors seems ameliorated in blacks compared to whites.     

Trends in risk factor control in Germany 1984-1998: high blood pressure and total cholesterol

BACKGROUND: Diagnosis and treatment of the two primary cardiovascular risk factors, hypertension and hypercholesterolaemia, are well established. Nevertheless, according to earlier analyses of representative health questionnaire and examination surveys in 1984, 1988 and 1991, control of risk factors in the sense of normalized values through drug therapy did not improve to any relevant degree in former West Germany. The National Health Survey of 1998 now allows the reconsideration of the hypothesis that medical treatment has been improving and lead to a reduction of risk factor values measured in the population. METHODS: Datasets of independent cross-sectional studies in 1984, 1988, 1991 and 1998 with net random sample sizes between 3,458 and 5,335 were analysed for actual (persons with elevated values and persons successfully treated) and population (persons with elevated values) prevalence, awareness of the risk factors under question, treatment coverage (risk factor aware and treated) and effectiveness (risk factor aware, treated and normalized), and the resulting parameters of controlled (successfully treated persons among actual prevalence) and uncontrolled prevalence (persons with elevated values among actual prevalence), respectively. Thresholds chosen were blood pressure values >or=160/95 mmHg for hypertension and values >or=250 mg/dl for hypercholesterolaemia. Regarding medication, the answer of 'one to two times weekly' or more was considered to indicate a relevant drug intake. RESULTS: For hypertension the population prevalence (population 30-69 years old) increased significantly (P < 0.0001) from 19.6% to 24.0% between 1984 and 1998, whereas the actual prevalence rose less steeply but still significantly (P < 0.0002) from 32.5% to 34.4%. For hypercholesterolaemia the population prevalence stagnated at 37.0% (1998), whereas the actual prevalence was 47.5% in 1998 (39.1% in 1984; P < 0.0001). For hypertension treatment, coverage improved from 45.4% to 63.0%, but treatment effectiveness decreased from 51.7% to 41.3%, both trends being highly significant. For hypercholesterolaemia, awareness increased from 18.3% to 57.6%, but treatment coverage decreased from 33.5% to 15.5%, whereas treatment effectiveness improved from 23.8% to 47.7%, all trends being highly significant (P < 0.0001). CONCLUSIONS: The results do not support the hypothesis that medical care for the large population at cardiovascular risk in (Western) Germany was adequate and successful in the 1980s and 1990s.     

Obesity and elevated blood pressure among adolescents in Lagos, Nigeria: a cross-sectional study

ABSTRACT: BACKGROUND: Childhood obesity and associated hypertension are major public health concerns globally. This study aimed to determine the prevalence of obesity and the associated risk of high blood pressure among Nigerian adolescents. METHODS: A cross-sectional school-based study of 885 apparently healthy adolescents was performed. Weight, height and blood pressure (BP) were measured using standard methods. Body mass index (BMI) was calculated and categorized by age, sex and percentile. Obesity and overweight were defined as: [greater than or equal to] 95th and 85th to < 95th percentiles, respectively, for age, sex and height. Subjects were sub-categorized into age 10-13 years (A) and 14-17 years (B). The odds ratio for pre-hypertensive and hypertensive range BP by age and BMI were generated. Significance was set at P < 0.05. RESULTS: The prevalence of overweight and obesity were 13.8% and 9.4%, respectively. The prevalence of hypertensive range systolic BP and diastolic BP in obese subjects was 16% compared with 2.3% in normal BMI subjects (P = 0.00), and was 12.1% for females versus 6.4% in males (P = 0.27). The prevalence of hypertensive range diastolic BP was 15.2% in obese subjects versus 3.5% in normal subjects (P = 0.01), and 12% in females versus 1.4% in males (P = 0.00). BMI in group B was significantly associated with pre-hypertensive and hypertensive range systolic BP in overweight (P = 0.01, P = 0.002) and obese subjects (P = 0.00, P = 0.00) and with hypertensive range diastolic BP (P = 0.00) only in obese subjects. The only significant association in group A was between obesity and pre-hypertensive range diastolic BP (P = 0.00). CONCLUSION: The prevalence of hypertensive range BP among obese Nigerian adolescents was high. Screening for childhood obesity and hypertension, and long-term follow-up of obese adolescents into adulthood are recommended.     

Hypercholesterolemia prevalence, awareness, and treatment in blacks and whites: the Minnesota Heart Survey

Two cross-sectional population-based surveys were conducted in 1985 and 1986 to describe cardiovascular risk factors in blacks and whites in the Twin Cities. A total of 1,254 blacks and 2,934 whites ages 35-74 years participated. The surveys consisted of a home interview followed by survey center visit during which nonfasting serum total cholesterol level was measured and medication use during the past year was reviewed. Age-adjusted mean values for serum total cholesterol were significantly higher among white than black participants for both men (207 vs 193 mg/dl, P less than 0.001) and women (206 vs 202 mg/dl, P less than 0.05). Blacks had significantly higher serum HDL cholesterol levels than whites (men, 49 vs 41 mg/dl, P less than 0.001; women, 56 vs 54 mg/dl, P less than 0.01). The age-adjusted prevalence of hypercholesterolemia (serum total cholesterol greater than or equal to 240 mg/dl on the day of survey and/or current use of cholesterol lowering medication) was significantly higher among white than black men (18.3% vs 12.2%, P less than 0.01). No significant race differences were noted for women (whites, 19.7% vs blacks, 16.6%). Among hypercholesterolemic men, 66% of whites current use of cholesterol lowering medication) was significantly higher among white than black men (18.3% vs 12.2%, P less than 0.01). No significant race differences were noted for women (whites, 19.7% vs blacks, 16.6%). Among hypercholesterolemic men, 66% of whites current use of cholesterol lowering medication) was significantly higher among white than black men (18.3% vs 12.2%, P less than 0.01). No significant race differences were noted for women (whites, 19.7% vs blacks, 16.6%). Among hypercholesterolemic men, 66% of whites and 80% of blacks were unaware of their condition; among women, 72% of whites and 79% of blacks were unaware. Among individuals told by a physician they had "high blood fats," 2.9% of whites and no blacks were using medication for elevated blood cholesterol levels, while 70% of whites and 63% of blacks reported being advised to follow a low-fat-low-cholesterol diet. These data emphasize the need for education programs for physicians and patients regarding detection and control of hypercholesterolemia.