title: Age, Race and Cardiovascular Outcomes in African American Veterans.
abstract: In the general population, compared wtih their White peers, African Americans suffer premature all-cause and cardiovascular (CV) deaths, attributed in part to reduced access to care and lower socioeconomic status. Prior reports indicated younger (aged 35 to 44 years) African Americans had a signficantly greater age-adjusted risk of death. Recent studies suggest that in a more egalitarian health care structure than typical United States (US) health care structures, African Americans may have similar or even better CV outcomes, but the impact of age is less well-known.
  
  
  
  We examined age stratified all-cause mortality, and incident coronary heart disease (CHD) and ischemic stroke in 3,072,966 patients (547,441 African American and 2,525,525 White) with an estimated glomerular filtration rate (eGFR)>60 mL/min/1.73m(2) receiving care from the US Veterans Health Administration. Outcomes were examined in Cox models adjusted for demographics, comorbidities, kidney function, blood pressure, socioeconomics and indicators of the quality of health care delivery.
  
  
  
  African Americans had an overall 30% lower all-cause mortality (P<.001) and 29% lower incidence of CHD (P<.001) and higher incidence of ischemic stroke (aHR, 95%CI: 1.16, 1.13-1.18, P<.001). The lower rates of mortality and CHD were strongest in younger African Americans and attenuated across patients aged ≥70 years. Stroke rates did not differ by race in persons aged <70 years.
  
  
  
  Among patients with normal eGFR and receiving care in the Veterans Health Administration, younger African Americans had lower all-cause mortality and incidence of CHD and similar rates of stroke, independent of demographic, comorbidity and socioeconomic differences. The lower all-cause mortality persisted but attenuated with increasing age and the lower incidence of CHD ended at aged ≥80 years. The higher incidence of ischemic stroke in African Americans was driven by increasing risk in patients aged ≥70 years suggesting that the improved cardiovascular outcomes were most dramatic for younger African Americans.
authors.affiliation: David Geffen School of Medicine; University of California, Los Angeles.
authors.forename: Keith C
authors.initials: KC
authors.lastname: Norris
authors.affiliation: National Heart, Lung, and Blood Institute, National Institutes of Health.
authors.forename: George A
authors.initials: GA
authors.lastname: Mensah
authors.affiliation: Department of Medicine, Duke University.
authors.forename: L Ebony
authors.initials: LE
authors.lastname: Boulware
authors.affiliation: University of Tennessee Heath Science Center.
authors.forename: Jun L
authors.initials: JL
authors.lastname: Lu
authors.affiliation: University of Virginia.
authors.forename: Jennie Z
authors.initials: JZ
authors.lastname: Ma
authors.affiliation: University of California, Irvine.
authors.forename: Elani
authors.initials: E
authors.lastname: Streja
authors.affiliation: University of Tennessee Heath Science Center.
authors.forename: Miklos Z
authors.initials: MZ
authors.lastname: Molnar
authors.affiliation: University of California, Irvine.
authors.forename: Kamyar
authors.initials: K
authors.lastname: Kalantar-Zadeh
authors.affiliation: University of Tennessee Heath Science Center; Memphis VA Medical Center.
authors.forename: Csaba P
authors.initials: CP
authors.lastname: Kovesdy
mesh_terms: D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D015897:Comorbidity; D003327:Coronary Disease / Q000208:ethnology / Q000401:mortality*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D044469:Racial Groups; D020521:Stroke / Q000208:ethnology / Q000401:mortality*; D014481:United States; D014728:Veterans; D044465:White People
keywords: African American; Age; Chronic Kidney Disease; Coronary Heart Disease; Incidence; Mortality; Race; Stroke