Diabetes and CVD Risk: Special Considerations in African Americans Related to Care
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RACE AND ETHNICITY DISPARITIES (M. ALBERT AND L. BREWER, SECTION EDITORS)
Diabetes and CVD Risk: Special Considerations in African Americans Related to Care Jennifer A. Wittwer 1 & Sherita Hill Golden 2 & Joshua J. Joseph 1 Published online: 8 August 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Among patients with type 2 diabetes (T2D), cardiovascular disease (CVD) is the leading cause of death regardless of ethnicity. However, recent studies suggest that special considerations should be taken into account when caring for African Americans with T2D, as risk factors, incidence, prevalence, and mortality differ from other populations. This review highlights literature supporting the unique characteristics of managing cardiovascular risk and mortality in African Americans (AAs) with T2D. Recent Findings African Americans have an increased risk of developing T2D and have a higher prevalence of T2D compared with non-Hispanic whites. Certain cardiovascular risk factors, including hypertension and obesity, are particularly challenging in African Americans with T2D and influence CVD and mortality. Treatment regimens including lifestyle modification, pharmacologic interventions, and surgery to manage T2D in patients of all populations may not produce equitable outcomes in African Americans. Particularly, newer cardiovascular outcome trials for sodium-glucose co-transporter 2 (SGLT2) inhibitors and glucose-like peptide 1 receptor (GLP-1R) agonists have disparate effect estimates for major adverse cardiovascular event reduction in African Americans. Thus, research focused on cardiovascular risk reduction in African Americans is of paramount importance. Summary In summary, there are numerous discrepancies in the outcomes of recent cardiovascular risk trials for the diagnosis, assessment and treatment of African Americans with T2D. Future investigations must lead to improved cardiovascular outcomes through evidence-based care of T2D in African Americans if we are to continue to lower the burden of CVD in the USA. Keywords Diabetes . African Americans . Cardiovascular disease . Social determinants of health . Health disparities . Antihyperglycemic medications
Introduction Epidemiology Diabetes prevalence has quadrupled since the 1980s, and presently, over 34.2 million people in the USA (US) have diabetes Topical Collection on Race and Ethnicity Disparities * Joshua J. Joseph [email protected] Jennifer A. Wittwer [email protected] Sherita Hill Golden [email protected] 1
Division of Endocrinology, Diabetes and Metabolism, The Ohio State University College of Medicine, 579 McCampbell Hall, 1581 Dodd Drive, Columbus, OH 43210, USA
2
Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA
with greater than 90–95% being classified as type 2 diabetes (T2D) [1]. The incidence and prevalence of diabetes differs between racial/ethnic groups. African Americans (AAs) have the second highest incidence and prevale
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