Two-thirds of African-American men may be at high risk for cardiovascular disease

A new University of Florida study finds that 65 percent of African-American men over age 40 are at high risk of having a heart attack or stroke within the next 10 years.

That percentage represents a substantial increase over time, from 53.5 percent in 1999. The findings appear today in the American Journal of Preventive Medicine.

“Not only has this population shown a rise in risk, a significant majority of this group is at high risk for a 10-year major cardiovascular event. This is quite worrisome,” said lead investigator Arch G. Mainous III, Ph.D., chair of the department of health services research, management and policy in the UF College of Public Health and Health Professions, part of UF Health.

The cardiovascular disease risk for most other population groups the team examined remained constant over time and actually decreased for two. Among white women, the prevalence of high cardiovascular disease risk fell from 9.6 percent to 5.8 percent, and among African-American women, the prevalence dropped from 15 percent to 10.6 percent.

The study didn’t examine the reasons why African-American men’s cardiovascular disease risk factors have risen over time, but several elements may play a role, said co-author Ki Park, M.D., a clinical assistant professor of medicine in interventional cardiology at the UF College of Medicine and the Malcom Randall Veterans Affairs Medical Center. These may include inadequate prevention measures aimed at racial subgroups, psychosocial elements and a lack of access to routine health care.

Mainous says the findings underscore the importance of prevention efforts targeted to African-American men, such as lowering their blood pressure and making lifestyle changes. Using tools that calculate heart disease risk scores can help identify people who could benefit from early interventions.

“The value of computing these risk scores is so we know who is at high risk and we can intervene,” he said. “It’s too late to wait until people have strokes.”

In 2013, the American College of Cardiology and the American Heart Association released the Atherosclerotic Cardiovascular Disease, or ASCVD, risk score. The ASCVD risk score uses weighted variables, including age, sex, race/ethnicity, smoking status, diabetes status, cholesterol, blood pressure and blood pressure medication status, to calculate individuals’ risk of having a heart attack or stroke within the next 10 years.

The UF study is the first to apply the tool on a population basis to identify groups, based on age, race and gender, that might be at high risk.

For the study, researchers analyzed data for the years 1999 to 2014 from the National Health and Nutrition Examination Survey, a nationally representative study that collects data from a combination of interviews, physical examinations and laboratory tests. They calculated the ASCVD risk score for participants ages 40 to 79 who did not have a previous diagnosis of coronary heart disease, stroke or heart attack.

A score of 7.5 percent or higher is considered high risk. The American College of Cardiology and the American Heart Association recommend drug therapy and lifestyle changes for people who score a 7.5 percent or higher risk of having a heart attack or stroke within 10 years.

The UF researchers found that non-Hispanic black men experienced a significant increase in risk during the 15-year period they examined, rising from 53.5 percent to 65 percent. In comparison, the prevalence of high cardiovascular disease risk among white men was 44.5 percent in 1999 and 48.2 percent in 2014.

Experts don’t know how frequently physicians use the ASCVD in clinical practice, Park said. “However, it is known that risk scores are generally underutilized and vary between general practitioners and subspecialists,” she said.

Mainous said the ASCVD risk score should be better integrated into clinical practice. It is easy to use, available for free online and gives physicians an accurate assessment of risk without having to judge a patient’s risk based on their own calculation of individual risk factors.

“Using validated, multivariable risk scores in practice is the best way to understand your patient population and who is at risk,” said Mainous, the Florida Blue endowed chair of health administration. “Physicians need to use these tools and patients need to know what their risk score is.”

In addition to Mainous and Park, the UF study team included Rebecca Tanner, M.A., a research coordinator; Ara Jo, Ph.D., a clinical assistant professor; and V. Madsen Beau De Rochars, M.D., M.P.H., an assistant professor, all from the department of health services research, management and policy.