Cardiovascular Disease

Diabetic African Americans have more macro-vascular disease than non-diabetics (173, 174). However, among diabetic subjects, African Americans have less atherosclerotic cardiovascular disease than whites. The frequency of angina and myocardial infarction was 2.3 and 3.0 times greater in newly diagnosed and 50-20% higher in previously diagnosed whites compared to African American diabetic subjects in NHANES II (7). This is of interest because newly diagnosed African Americans smoked more than whites (42% vs 28.7%) and smoking is a major C-V risk factor (7). Similarly, Afro-Caribbean blacks in

England had half the hospitalizations for heart attacks (6% vs 13%) compared to whites despite the greater rate (31% vs 14%) of diabetes (7,8).

The lower rate of myocardial infraction and angina in African Americans compared to whites with Type 2 diabetes is consistent with their lower serum triglycerides and higher HDL cholesterol levels (adjusted for BMI) (9). African American men and women with diabetes versus those without had significantly lower total LDL-cholesterol and triglycerides and higher HDL-cholesterol (NHANES II) (69) (Figure 9A.8). In contrast, LDL-cholesterol was slightly higher in white diabetics versus non-diabetics (68). These epidemiologic data showing lower rates of macro vascular disease and favorable lipids are consistent with the

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heterogenous pathophysiology of Type 2 diabetes in African Americans: up to 30% of African American diabetics are insulin-sensitive with lower triglyceride and LDL-cholesterol levels (67,72). Also, non-diabetic African Americans compared to whites have higher HDL cholesterol levels and lower triglyceride levels (175-178).

Hypertension is a major risk factor for both macrovascular and microvascular disease and African Americans with and without diabetes have higher blood pressure than whites (7). The frequency of hypertension in the general population increases with age; however, among African Americans and whites with diabetes, the frequency of hypertension decreases after the age of 55 years. This may be related to increased mortality of

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Figure 9A.8 Frequency of dyslipidemia in black and white adults, age 40-69 years with and without Type 2 diabetes, US 1976-80, NHANES II

Panel A: total cholesterol >240 mg/dl, (B) LDL-cholesterol >160 mg/dl, (C) HDL-cholesterol <35 mg/dl, (D) fasting triglyceride >250 mg/dl

Source: Reproduced from (69) by permission diabetic subjects with hypertension. The majority of non diabetic African Americans and whites do not have hypertension (60% and 70% respectively). The majority of diabetics do have hypertension: 63%-80% among African Americans and 40-60% among whites.

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