Management of Cardiovascular Risk Factors in Racial and Ethnic Minorities with Type-2 Diabetes

Management of Cardiovascular Risk Factors in Racial and Ethnic Minorities with Type-2 Diabetes

Annemarie Armani, Ferdinand Keith C
US Endocrine Disease 2006 Issue 2
Published: October 2008
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Type-2 diabetes, which involves a perilous clustering of cardiovascular risk factors, primarily elevated blood pressure, atherogenic dyslipidemia and increased vascular thrombosis, affects 18 million Americans and is expected to reach almost epidemic proportions in the next decade.1 Persons with type-2 diabetes are at a dramatically increased risk for the development of cardiovascular events, specifically acute myocardial infarction (MI) and stroke. A diagnosis of diabetes presents the same cardiovascular risk as those who have already had MI, deeming it a ‘coronary risk equivalent’.2 More than 65% of deaths in diabetes patients are attributed to heart and vascular disease.1 Although mortality from coronary heart disease (CHD) has been decreasing overall in the US in the last several decades, the increasing prevalence of type-2 diabetes may ultimately slow or reverse this trend.

Racial and ethnic minorities in the US are disproportionately afflicted with diabetes (see Figure 1 and Table 1) and type-2 diabetes is considerably more common in African-Americans than in whites.3–5 In the Atherosclerosis Risk in Communities Study, the incidence of diabetes was 2.4 times greater in African- American women and 1.5 times greater in African- American men than in their white counterparts.6

Diabetes also disproportionately affects Hispanics in the US.7 Hispanic/Latino Americans are 1.5 times more likely, with Mexican Americans—the largest Hispanic/Latino subgroup—more than twice as likely to have diabetes as non-Hispanic whites of similar age. Residents of Puerto Rico are also 1.8 times more likely to have diagnosed diabetes than non-Hispanic white Americans. Although studies have determined that overweight and obesity contribute heavily to racial/ethnic disparities in diabetes prevalence, Hispanics still have higher prevalence of diabetes than non-Hispanic whites at each level of body mass index (BMI).8With the presence of obesity, insulin resistance and diabetes in Hispanic Americans, it is expected that rates of CHD will markedly increase over the next several years.

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