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Avis J. Thomas, MS, Lynn E. Eberly, PhD, George Davey Smith, MD, DSc, James D. Neaton, PhD, Jeremiah Stamler, MD for the Multiple Risk Factor Intervention Trial Research Group

Avis J. Thomas, Lynn E. Eberly, and James D. Neaton are with the Coordinating Centers for Biometric Research, Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis. George Davey Smith is with the Department of Social Medicine, University of Bristol, Bristol, England. Jeremiah Stamler is with the Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill.

Correspondence: Requests for reprints should be sent to Avis J. Thomas, MS, Coordinating Centers for Biometric Research, University of Minnesota, 2221 University Ave SE, Suite 200, Minneapolis, MN 55414 (e-mail: avist{at}ccbr.umn.edu).

Objectives. We explored differences between Black and White men for cardiovascular disease (CVD) mortality across major risk factor levels.

Methods. Major CVD risk factors were measured among 300 647 White and 20 223 Black men aged 35 to 57 years who were screened for the Multiple Risk Factor Intervention Trial (MRFIT). Hazard ratios for CVD deaths for Black and White men over 25 years of follow-up were calculated for subgroups stratified according to risk factor levels.

Results. CVD was responsible for 2518 deaths among Black men and 30772 deaths among White men. The age-adjusted Black-to-White CVD hazard ratio was 1.35 (95% confidence interval [CI]=1.29, 1.40); the risk- and income-adjusted ratio was 1.05 (95% CI=1.01, 1.10). CVD mortality rates were dramatically lower in cases of favorable risk profiles. However, fully adjusted Black-to-White CVD hazard ratios within groups at low, intermediate, high, and very high levels of overall risk were 1.76, 1.20, 1.10, and 0.94, respectively. Similar gradients were evident for individual risk factors.

Conclusions. Higher CVD mortality rates among Black men were largely mediated by risk factors and income. These data underscore the need for sustained primordial risk factor prevention among Black men.

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