Avis J. Thomas ^1*, Lynn E. Eberly ¹, George Davey Smith ², James D. Neaton ³, Jeremiah Stamler ⁴

¹ University of Minnesota
² University of Bristol
³ Univeristy of Minnesota
⁴ Northwestern University Medical School

^* To whom correspondence should be addressed. E-mail: avist{at}ccbr.umn.edu.

	Abstract

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

Methods: Major CVD risk factors were measured among 300 647 White and 20 223 Black men aged 35-57 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 30 772 deaths among White men. The age-adjusted Black-to-White CVD hazard ratio was 1.35 (95% [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.

Key Words: Cardiovascular Disease, African Americans/Blacks, Race/Ethnicity, Socioeconomic Factors

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