The three leading causes of death in African Americans: barriers to reducing excess disparity and to improving health behaviors.

African Americans suffer disproportionately from several major health problems associated with high morbidity and mortality. The 1985 DHHS Secretary's Task Force Report on Blacks and Other Minorities identified six major disease categories of excess deaths for African Americans compared with whites by applying the lower death rate for whites to the American population. The report provided a stimulus for public and private action to begin to address the health disparities between minority and nonminority populations. This article examines three of the leading causes of death for African Americans and assesses the extent to which the health disparity between African Americans and whites has been reduced. The three leading causes of death for African American males are diseases of the heart, cancer, and HIV infection/AIDS. The conditions are the same for African American females except stroke replaces HIV infection. Three health outcomes measures are discussed: life expectancy, excess death rates, and years of potential life lost. A widening of the gap between the races was found for diseases of the heart and HIV infection for males and for cancer for females. An extensive list of barriers to reducing the disparity are presented from the scientific literature and strategies for reducing the three health problems are recommended.

Setting the agenda for research and education on coronary heart disease.

Coronary heart disease (CHD) disproportionately affects the African American population with death and disability. The disparity in mortality continues to exist between the general population and African Americans despite decreases in death rates in both groups since the 1970s. The National Heart, Lung, and Blood Institute (NHLBI) is committed to developing and supporting research and activities that improve the health of African Americans through community partnership initiative. One such initiative is the CHD in Blacks Project, developed to increase awareness of the adverse effects of CHD, encourage healthy lifestyle behaviors, and, among health professionals, ensure that the latest treatment guidelines from the NHLBI in high blood pressure, high blood cholesterol, and obesity are used. The NHLBI has also established a network of health professionals from across the country to assist in developing medical education programs and community education outreach activities in conjunction with the National Medical Association, the Association of Black Cardiologists, and the National Black Nurses Association.

Youth health report card: asthma.

Asthma is a serious, chronic illness among U.S. children. Approximately 6% of all children under 18 years of age in the United States suffer from asthma--prevalence rates in our inner cities are even higher. The impact this disease has on children, their families, and society is profound and easily translatable into loss of time at work and school, a concomitant loss of productivity, and added stress to an already overburdened health care system. Recognizing the significance of asthma as a serious public health problem, Healthy People 2000 has targeted improvements in asthma care as one of its objectives and the National Heart, Lung, and Blood Institute has research and education programs to improve the health of our children with asthma.

High-density lipoprotein cholesterol and alcohol consumption in US white and black adults: data from NHANES II.

OBJECTIVES: High-density lipoprotein (HDL) cholesterol is known to be positively related to moderate alcohol consumption from studies in selected populations. This study describes the association in a representative sample of the US adult population. METHODS: Stratification and multivariate regression analyses were used to examine HDL cholesterol levels and alcohol consumption. RESULTS: Fewer women than men reported consumption of alcohol at any frequency. Similar percentages of Whites and Blacks reported alcohol consumption. Age-adjusted mean HDL cholesterol levels were higher among alcohol drinkers than among nondrinkers in all sex-race strata. Mean HDL cholesterol levels of Whites and Blacks of both sexes increased consistently with increased frequency of consumption of beer, wine, and liquor. With age, education, body mass index, smoking, and physical activity controlled for, there were higher age-adjusted HDL cholesterol levels with increasing reported quantities of alcohol consumed. Daily or weekly use of alcohol led to an increase of 5.1 mg/dL in mean HDL cholesterol level, whereas consumption of 1 g of alcohol led to an increase of 0.87 mg/dL. CONCLUSION: Even if there is a causal association between alcohol consumption and higher HDL cholesterol levels, it is suggested that efforts to reduce coronary heart disease risks concentrate on the cessation of smoking and weight control.

Serum total cholesterol: HDL cholesterol ratios in US white and black adults by selected demographic and socioeconomic variables (HANES II).

BACKGROUND: Framingham Study findings suggest that total cholesterol (TC):High density lipoprotein cholesterol (HDL-C) ratio is a useful summary of the joint contribution of TC and HDL-C to coronary heart disease (CHD) risk. Information on the distribution of TC:HDL-C in the US population is limited to selected populations and the relationship of the ratio distribution and its correlates has received little attention. METHOD: TC/HDL-C ratios were examined in a representative sample of the United States adult population ages 20 to 74 years, between February 1976 and February 1980 during NHANES II, using stratification and multivariate regression analyses. RESULTS: Age-adjusted mean ratios were higher in men compared with women and were higher in Whites compared with Blacks. White men had the highest TC/HDL-C mean ratios. These relationships remained after stratification by age, education, body mass index, alcohol use, cigarette smoking, and physical activity. Using multivariate analyses, the ratios were positively related to BMI, age, and smoking; and negatively related to female sex, alcohol use, being Black, and physical activity. CONCLUSIONS: Using a ratio reference point of greater than or equal to 4.5 from the Framingham study, at least an estimated 44 million persons ages 25 to 74 years in the US were found to be at higher risk of developing coronary heart disease.

Serum lipids and lipoproteins of Hispanics, 1982-84.

This report presents descriptive data for serum lipids and lipoproteins by age, sex, and selected socioeconomic variables. This information is from the Hispanic Health and Nutrition Examination Survey, a sample survey of selected groups of civilian noninstitutionalized Hispanic persons residing in selected area of the United States, that was conducted during the period 1982-84.

Serum alpha-tocopherol levels of Mexican Americans, Cubans, and Puerto Ricans aged 4-74 y.

Data from the Hispanic Health and Nutrition Examination Survey were used to examine serum alpha-tocopherol levels (in subjects aged 4-74 y) and ratios of alpha-tocopherol to cholesterol plus triglyceride and to cholesterol (in subjects aged 20-74 y) of Mexican Americans (MA), Cubans, and Puerto Ricans (PR). Neither alpha-tocopherol nor the alpha-tocopherol-lipid ratios differed between sexes. PR had lower mean alpha-tocopherol and alpha-tocopherol-lipid ratios and higher prevalences of alpha-tocopherol less than 11.6 mumol/L than did MA or Cubans in several age groups. MA and Cuban adolescents had lower alpha-tocopherol levels than children had. Mean alpha-tocopherol levels and alpha-tocopherol-lipid ratios increased and prevalences of alpha-tocopherol less than 11.6 mumol/L decreased during adulthood in all three ethnic groups.

The prevalence of high blood cholesterol levels among adults in the United States.

Using the National Cholesterol Education Program's Guidelines for the Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults and the most recent nationally representative serum total cholesterol and lipoprotein data for adults (ages 20 to 74 years) from the second National Health and Nutrition Examination Survey (1976 to 1980), it is estimated that 41% of adults should have lipoprotein analysis after an initial measurement of serum total cholesterol. Furthermore, it is estimated that 88% of those who need lipoprotein analysis, or 36% of all adults aged 20 to 74 years, are candidates for medical advice and intervention for high blood cholesterol levels. We estimate, based on 1986 population data, that approximately 40 million Americans between the ages of 20 and 59 years are candidates for medical advice and intervention. An additional 24 million Americans aged 60 years and older are candidates. Overall, we estimate that about 60 million Americans aged 20 years and older are candidates for medical advice and intervention for high levels of blood cholesterol, although a less intensive approach might be appropriate for elderly patients.

High density lipoprotein cholesterol levels among US adults by selected demographic and socioeconomic variables. The Second National Health and Nutrition Examination Survey 1976-1980.

The distribution of serum high density lipoprotein cholesterol (HDL cholesterol) levels was determined on a nationally representative sample of 9,625 adults aged 20-74 years, as part of the Second National Health and Nutrition Examination Survey, 1976-1980 (NHANES II). Mean HDL cholesterol levels were higher in women compared with men (an age-adjusted difference of 8.9 mg/dl for whites and 4.4 mg/dl for blacks). HDL cholesterol levels were higher in blacks compared with whites (an age-adjusted difference of 7.4 mg/dl for men and 2.8 mg/dl for women). All differences were statistically significant (p less than 0.01). These relations remained after stratification by age, income, poverty index, education, body mass index, alcohol consumption, cigarette smoking, and physical activity. For whites, HDL cholesterol levels were highest in the highest category of earnings, whereas blacks generally had lower levels of HDL cholesterol with increased earnings. In a multivariate model, important predictors of higher HDL cholesterol levels were being female, being black, and reporting a higher frequency of alcohol consumption. Less strongly related were age, years of education, and reported high physical activity. Smoking and body mass index were strongly negatively related to HDL cholesterol levels. The findings in this national study support previous findings in selected populations in the United States.

Enzymatic analysis of total- and HDL-cholesterol: comparison with the standardized Liebermann-Burchard method used by the Lipid Research Clinics program.

We compared two enzymatic cholesterol methods with the standardized chemical method used in the Lipid Research Clinic's (LRC) program. The methods were used to measure total cholesterol and high density lipoprotein (HDL) cholesterol in heparin-MnCl2 supernatants of 1,812 sera collected over a 16-mth period from subjects who were sampled as part of the Hispanic Health and Nutrition Examination Survey. Thirty percent of the subjects had fasted for 12 h or more before venepuncture. The enzymatic total cholesterol values were 1.4-1.8% lower than the LRC method and both enzymatic methods correlated highly with the LRC method (r greater than 0.97). The enzymatic HDL cholesterol values were 2.4 and 6.4% higher than the LRC method, and the correlation between the enzymatic and LRC methods was greater than 0.93. The differences between the enzymatic and LRC methods were the same in samples from fasting and non-fasting subjects.

Cardiovascular risk status and oral contraceptive use: United States, 1976-1980.

Data from the second National Health and Nutrition Examination Survey, conducted in 1976-1980, were analyzed for the prevalence of cardiovascular risk factors (cigarette smoking, serum cholesterol, and blood pressure) among 2,342 premenopausal women ages 20-44 years, stratified by oral contraceptive use. For oral contraceptive users and non-users, adjusted means were serum cholesterol, 205 vs 188 mg/dl (P less than 0.05); systolic blood pressure, 116 vs 113 mm Hg (P less than 0.01); and diastolic blood pressure, 74 vs 73 mm Hg (NS). The prevalence of cigarette smoking was significantly higher among oral contraceptive users (44% compared with 36% among nonusers; P less than 0.05). Using the 1984 NIH Consensus Development Conference Statement on Lowering Blood Cholesterol to define risk levels for serum cholesterol, 23% of the oral contraceptive users were at high risk compared with 12% of the nonusers, and 16% of the oral contraceptive users vs 11% of the nonusers were at moderate risk. For users and nonusers, the respective prevalence of a blood pressure at or above 140/90 mm Hg was 5.3% vs 8.8% (unadjusted) and 8.6% vs 8.0% (age adjusted). The percentage of women with multiple risk factors was also higher among oral contraceptive user; 14% of the users had two or more risk factors vs 7% of the nonusers (P less than 0.05). These cross-sectional national data support data from clinical studies regarding the effect of oral contraceptives on cholesterol and blood pressure levels. In addition, since the use of oral contraceptives is widespread in the population and users tend to see physicians more regularly than other women, the data suggest that users of the pill are a good target group among which to screen and monitor cardiovascular risk factors.

Coronary heart disease risk factor trends in blacks between the first and second National Health and Nutrition Examination Surveys, United States, 1971-1980.

This article focuses on changes in prevalence of three of the major risk factors for coronary heart disease (CHD) among the black population aged 25 to 74 years: blood pressure, cigarette smoking, and serum cholesterol. It also examines the extent to which changes in these risk factors might explain changes in observed CHD mortality. These national estimates of risk factor levels among the black U.S. population are based on cross-sectional data from the National Health and Nutrition Examination Surveys of 1971-1975 and 1976-1980. Results of analyses show that there was a large and statistically significant decrease in the prevalence of elevated blood pressure for black adults between the two time periods; there was a large, significant decrease in the percent of black females who smoke and a smaller decrease in the proportion of black males who smoke; and there was no statistically significant change in the prevalence of elevated serum cholesterol. In addition, the percent of black adults with two or more risk factors decreased between 1971-1975 and 1976-1980. Lower levels of the three risk factors appear to explain a portion of the decline in observed CHD mortality for blacks. However, despite the encouraging lower prevalence of risk factors for blacks, more than 60% of the black adults 25 to 74 years of age still had one or more CHD risk factors in 1976-1980.