Multiple Cardiovascular Problems Linked to Higher Death Risk in Black Adults

In a study group of Black adults, certain combinations of cardiovascular risk factors — namely diabetes, a history of stroke, or coronary artery disease (CAD) — were linked to a higher risk of dying, according to a new study published in the journal JAMA Network Open[1].

Research has shown that Black Americans are at higher risk for certain poor outcomes related to diabetes and cardiovascular disease. This includes a higher rate of diabetes-related deaths[2], a higher amputation risk[3] for people with diabetic foot ulcers[4], and a higher rate of hospital readmissions[5] for diabetic ketoacidosis[6] (DKA, a life-threatening condition marked by a very high blood glucose level) among children with diabetes. Some studies have also been focused solely on Black people, without making any comparisons between groups — including research showing that waist size predicts the risk for developing type 2 diabetes[7], and that consuming more ultra-processed foods is linked to high blood pressure[8] in Black adults.

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For the latest study, researchers followed a group of 5,064 Black adults, ages 21 to 94, for a median duration of about 15 years. These participants all resided in the Jackson, Mississippi, metropolitan area, and received three health examinations as part of the study — an initial exam between 2000 and 2004, a follow-up exam between 2005 and 20087, and a final health exam between 2009 and 2013. The researchers were mainly interested in looking at factors linked to death from all causes, as well as death specifically due to coronary artery disease.

Overall, 18% of participants had diabetes, 4% had coronary artery disease, and 2% had a history of stroke at the beginning of the study. Among participants with at least one of these risk factors, the lowest mortality rate was seen in those with diabetes alone — 24.4 deaths for every 1,000 years of life. The highest death risk was seen in those with all three risk factors — 84.1 deaths for every 1,000 years of life.

Cardiovascular risk factors linked to increased death risk

Compared with participants who didn’t have any of these risk factors, having diabetes alone was linked to 1.50 times the risk of dying, having coronary artery disease alone was linked to 1.59 times the risk of dying, and having a history of stroke alone was linked to 1.74 times the risk of dying. The combination of diabetes and stroke was linked to 1.71 times the risk of dying, the combination of coronary artery disease and stroke was linked to 2.23 times the risk of dying, and the combination of diabetes and coronary artery disease was linked to 2.28 times the risk of dying compared with having none of these risk factors at the beginning of the study. Having all three risk factors was linked to 3.68 times the risk of dying during the study period.

All of these risk factors, and combinations of risk factors, were linked in a similar way to the risk of dying specifically from coronary artery disease — except that the risk increase was much greater in each case. For example, the combination of diabetes, coronary artery disease, and stroke was linked to 13.52 times the risk of dying from coronary artery disease, compared with not having any of these risk factors at the beginning of the study.

The researchers concluded that among Black adults, having more cardiovascular risk factors was linked to a greater risk of dying — both from all causes and specifically from coronary artery disease. They noted, though, that these results should be interpreted with several limitations in mind — including that they adjusted for education level, job status, and lifestyle factors, but not for many other factors that had the potential to affect the risk of dying. And, of course, these results represent a specific population in just one metropolitan area — more research is needed to find out if similar trends are seen in Black populations, or other populations, throughout the United States.

Want to learn more about protecting your heart? Read “Be Heart Smart: Know Your Numbers,”[10] “Does Diabetes Hurt Your Heart?”[11] “Fight Off Heart Disease With These Five Heart-Healthy Foods”[12] and “Lower Your Risk of Heart Disease.”[13]

Endnotes:
  1. JAMA Network Open: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2797624
  2. higher rate of diabetes-related deaths: https://www.diabetesselfmanagement.com/news-research/2021/04/14/black-americans-face-increased-risk-of-death-from-diabetes/
  3. higher amputation risk: https://www.diabetesselfmanagement.com/news-research/2022/05/10/black-rural-residents-with-diabetic-foot-ulcers-see-high-foot-amputation-risk/
  4. diabetic foot ulcers: https://www.diabetesselfmanagement.com/education/diabetic-foot-ulcers-what-are-they-and-how-can-you-avoid-them/
  5. higher rate of hospital readmissions: https://www.diabetesselfmanagement.com/news-research/2022/05/23/hospital-readmission-for-dka-higher-for-black-children-poorer-neighborhoods/
  6. diabetic ketoacidosis: https://www.diabetesselfmanagement.com/managing-diabetes/blood-glucose-management/dka-what-to-know-and-how-to-deal/
  7. waist size predicts the risk for developing type 2 diabetes: https://www.diabetesselfmanagement.com/news-research/2021/10/01/waist-size-predicts-type-2-diabetes-risk-in-black-adults/
  8. is linked to high blood pressure: https://www.diabetesselfmanagement.com/news-research/2021/06/21/ultra-processed-foods-linked-to-hypertension-in-black-adults/
  9. sign up for our free newsletters: https://www.diabetesselfmanagement.com/newsletter/
  10. “Be Heart Smart: Know Your Numbers,”: https://www.diabetesselfmanagement.com/education/be-heart-smart-know-your-numbers/
  11. “Does Diabetes Hurt Your Heart?”: https://www.diabetesselfmanagement.com/education/does-diabetes-hurt-your-heart/
  12. “Fight Off Heart Disease With These Five Heart-Healthy Foods”: https://www.diabetesselfmanagement.com/blog/fight-off-heart-disease-five-heart-healthy-foods/
  13. “Lower Your Risk of Heart Disease.”: https://www.diabetesselfmanagement.com/managing-diabetes/complications-prevention/lower-risk-heart-disease/

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