African-Americans

African Americans have the highest overall CHD mortality rates and the highest out-of-hospital coronary death rates of any ethnic group in the United States, particularly at younger ages. The earlier age of onset of CHD in African Americans creates particularly striking African American/white differences in years of potential life lost for both total and ischemic heart disease. Although the reasons for the excess CHD mortality among African Americans have not been fully elucidated, these can be accounted for, at least in part, by the high prevalence and suboptimal control of coronary risk factors.

Hypertension, left ventricular hypertrophy, diabetes mellitus, cigarette smoking, obesity, physical inactivity, and multiple CHD risk factors all occur more frequently in African Americans than in whites. The predictive value of most conventional risk factors for CHD appears to be similar for African Americans and whites. However, the risk of death and other sequelae attributable to some risk factors (i.e., hypertension, diabetes) is disproportionately greater for African Americans. The Framingham risk assessment algorithm appears to have the same predictive value in African Americans as in whites. Nonetheless, among the risk factors, some differences have been observed between African Americans and whites. Although ATP III guidelines generally are applicable equally to African Americans and whites, differences in risk factors and/or genetic constitution call for special attention to certain features of risk management in African Americans.