title: Distributions of Subclinical Cardiovascular Disease in a Socioeconomically and Racially Diverse Sample.
abstract: Differential subgroup vulnerability to subclinical cardiovascular disease is likely, and yet few, if any, studies have addressed interactive relations of age, sex, race, and socioeconomic status (SES) to these conditions to examine nuances of known health disparities. We examined distributions of carotid atherosclerosis and arterial stiffness in a socioeconomically diverse, biracial, urban sample.
  
  
  
  Participants (n=2270) in the population-based HANDLS study (Healthy Aging in Neighborhoods of Diversity Across the Life Span; 30-64 years old, 44% men, 57% African American, 39% with household income <125% federal poverty threshold) underwent carotid intimal medial thickness (IMT) and pulse wave velocity assessment.
  
  
  
  In cross-sectional hierarchical regression analyses, interactive race×SES effects were identified for IMT and pulse wave velocity, such that high SES African Americans had significantly thicker IMTs and faster pulse wave velocities than all other subgroups (ie, low SES African Americans, low SES whites, and high SES whites). A race×sex effect was also identified for IMT, such that the IMT discrepancy between white men and women was more pronounced than the discrepancy between African American men and women. Finally, an SES×sex effect indicated that while IMTs of high SES and low SES men did not significantly differ, high SES women had marginally thicker IMTs than low SES women.
  
  
  
  High SES African Americans may be particularly vulnerable to subclinical cardiovascular diseases, placing them at enhanced risk for clinical cardiovascular diseases, including stroke. These findings suggest that male sex, low SES, and African American ancestry may represent imprecise generalizations as risk factors for subclinical cardiovascular disease.
authors.affiliation: From the Department of Psychology, University of Maryland, Baltimore County (C.R.W., S.R.W.); Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, NIH (C.R.W., M.K.E., A.B.Z.); Division of Gerontology & Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine (S.R.W.); and Geriatric Research Education and Clinical Center, Baltimore VAMC, MD (S.R.W.). crwendell@umbc.edu.
authors.forename: Carrington R
authors.initials: CR
authors.lastname: Wendell
authors.affiliation: From the Department of Psychology, University of Maryland, Baltimore County (C.R.W., S.R.W.); Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, NIH (C.R.W., M.K.E., A.B.Z.); Division of Gerontology & Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine (S.R.W.); and Geriatric Research Education and Clinical Center, Baltimore VAMC, MD (S.R.W.).
authors.forename: Shari R
authors.initials: SR
authors.lastname: Waldstein
authors.affiliation: From the Department of Psychology, University of Maryland, Baltimore County (C.R.W., S.R.W.); Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, NIH (C.R.W., M.K.E., A.B.Z.); Division of Gerontology & Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine (S.R.W.); and Geriatric Research Education and Clinical Center, Baltimore VAMC, MD (S.R.W.).
authors.forename: Michele K
authors.initials: MK
authors.lastname: Evans
authors.affiliation: From the Department of Psychology, University of Maryland, Baltimore County (C.R.W., S.R.W.); Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, NIH (C.R.W., M.K.E., A.B.Z.); Division of Gerontology & Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine (S.R.W.); and Geriatric Research Education and Clinical Center, Baltimore VAMC, MD (S.R.W.).
authors.forename: Alan B
authors.initials: AB
authors.lastname: Zonderman
mesh_terms: D000328:Adult; D001741:Black or African American / Q000208:ethnology*; D002340:Carotid Artery Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000208:ethnology*; D059168:Carotid Intima-Media Thickness; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D063177:Pulse Wave Analysis; D012737:Sex Factors; D012923:Social Class; D014481:United States / Q000208:ethnology; D059289:Vascular Stiffness; D044465:White People / Q000208:ethnology*
keywords: arterial stiffness; atherosclerosis; health disparities; intima–media thickness; pulse wave velocity; subclinical cardiovascular disease