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This review summarizes current knowledge about differences in cardiovascular disease and its risk factors among minorities in the US population. The limited information available about differences in the association of obesity with cardiovascular disease risk factors in minorities is described. Our thesis is that environment and its evolutionary influence are important in risk-factor changes, although genetic characteristics moderate the impact of these factors. This review attempts to illustrate how studies of minority groups can help us to understand the importance and interaction of factors leading to increased cardiovascular disease risk. We suggest guidelines for the design of studies that will help us to better explain differences in cardiovascular disease and its risk factors among minorities and to improve therapy for this common disorder. Because diabetes is a major topic of the First International Conference on Race, Ethnicity, and Health, data on this disease are used in many of the examples presented.

The relationship between blood pressure and blood lead levels in the second National Health and Nutrition Examination Survey (1976-1980) has been examined for white males aged 40-59 years. After adjustment for age, body mass index, nutritional factors, and blood biochemistries in a multiple linear regression model, the relationship of systolic and diastolic blood pressures to blood lead levels was statistically significant (p less than 0.01). There was no evidence of a threshold blood lead level for this relationship. Although these data alone do not prove a casual relationship between low blood lead levels and blood pressure, the findings are consistent with current epidemiologic and animal studies, indicating that a causal relationship is probable. To examine the potential health risks, the multiple logistic risk factor coefficients from the Pooling Project and Framingham studies were used to predict the impact of the 37% decrease in mean blood lead levels which occurred in adult white males from 1976 to 1980. As a result of this blood lead decrease, the calculations predicted a 4.7% decrease in the incidence of fatal and nonfatal myocardial infarction over 10 years, a 6.7% decrease in the incidence of fatal and nonfatal strokes over 10 years, and a 5.5% decrease in the incidence of death from all causes over 11.5 years. In addition, as a result of this blood lead decrease, the predicted number of white males in this age group with hypertension (diastolic blood pressure greater than or equal to 90 mmHg) decreased by 17.5%.

Cardiovascular conditions account for more medical costs than any other diagnostic category in the United States. Increasingly, economic constraints will shape policy related to health care and research. Hypertension is the most common cardiovascular condition, and despite low unit health care costs, the aggregate costs are considerable. However, the unit and aggregate costs of the complications of hypertension are fourfold greater and, in this economic perspective, aggressive approaches are warranted to prevent complications. Treatment and research strategies should be identified that could have considerable potential economic impact. Several strategies are suggested as a prospective guide to policy development. Economic considerations will be important and should be incorporated in the planning of hypertension care and research.