Skip to main content
Log in

Ethnic Minorities and Coronary Heart Disease: an Update and Future Directions

  • Coronary Heart Disease (S. Virani and S. Naderi, Section Editors)
  • Published:
Current Atherosclerosis Reports Aims and scope Submit manuscript

Abstract

Heart disease remains the leading cause of death in the USA. Overall, heart disease accounts for about 1 in 4 deaths with coronary heart disease (CHD) being responsible for over 370,000 deaths per year. It has frequently and repeatedly been shown that some minority groups in the USA have higher rates of traditional CHD risk factors, different rates of treatment with revascularization procedures, and excess morbidity and mortality from CHD when compared to the non-Hispanic white population. Numerous investigations have been made into the causes of these disparities. This review aims to highlight the recent literature which examines CHD in ethnic minorities and future directions in research and care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart disease and stroke statistics—2015 update: a report from the American Heart Association. Circulation. 2015;131:e29–322.

    Article  PubMed  Google Scholar 

  2. Chan PS. The gap in current disparities research a lesson from the community. Circ Cardiovasc Qual Outcomes. 2014;7:785–6.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Bureau UC. Millennials outnumber baby boomers and are far more diverse [internet]. Available from: http://www.census.gov/newsroom/press-releases/2015/cb15-113.html?intcmp=sldr2.

  4. Sardar M, Badri M, Prince CT, Seltzer J, Kowey PR. Underrepresentation of women, elderly patients, and racial minorities in the randomized trials used for cardiovascular guidelines. JAMA Intern Med. 2014;174:1868–70. An examination of RCTs which contributed to published guidelines which shows underrepresentation of women, minorities, and the elderly which may limit the generalizability of certain guidelines.

    Article  PubMed  Google Scholar 

  5. Census.gov [Internet]. [cited 2015 Jul 16]. Available from: http://www.census.gov/.

  6. Bureau UC. New census bureau report analyzes U.S. population projections [internet]. [cited 2015 Sep 12]. Available from: http://www.census.gov/newsroom/press-releases/2015/cb15-tps16.html.

  7. CDC - Hispanic - Latino - populations - racial - ethnic - minorities - minority health [internet]. [cited 2015 Jul 16]. Available from: http://www.cdc.gov/minorityhealth/populations/REMP/hispanic.html#10.

  8. Liao Y, Cooper RS, Cao G, Kaufman JS, Long AE, McGee DL. Mortality from coronary heart disease and cardiovascular disease among adult U.S. Hispanics: findings from the National Health Interview Survey (1986 to 1994). J Am Coll Cardiol. 1997;30:1200–5.

    Article  CAS  PubMed  Google Scholar 

  9. Rodriguez CJ, Allison M, Daviglus ML, Isasi CR, Keller C, Leira EC, et al. Status of cardiovascular disease and stroke in Hispanics/Latinos in the United States: a science advisory from the American Heart Association. Circulation. 2014;130:593–625. This is a comprehensive examination of cardiovascular disease in Hispanics in the USA. It not only describes traditional epidemiology concepts and risk factors but also touches on aspects of health and culture that are unique to Hispanics/Latinos.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Sorlie PD, Avilés-Santa LM, Wassertheil-Smoller S, Kaplan RC, Daviglus ML, Giachello AL, et al. Design and implementation of the Hispanic Community Health Study/Study of Latinos. Ann Epidemiol. 2010;20:629–41.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Sempos CT, Bild DE, Manolio TA. Overview of the Jackson Heart Study: a study of cardiovascular diseases in African American men and women. Am J Med Sci. 1999;317:142–6.

    Article  CAS  PubMed  Google Scholar 

  12. Investigators TA. The atherosclerosis risk in communit (aric) stui)y: design and objectwes. Am J Epidemiol. 1989;129:687–702.

    Google Scholar 

  13. Friedman GD, Cutter GR, Donahue RP, Hughes GH, Hulley SB, Jacobs DR, et al. CARDIA: study design, recruitment, and some characteristics of the examined subjects. J Clin Epidemiol. 1988;41:1105–16.

    Article  CAS  PubMed  Google Scholar 

  14. Bild DE, Bluemke DA, Burke GL, Detrano R, Roux AVD, Folsom AR, et al. Multi-Ethnic Study of Atherosclerosis: objectives and design. Am J Epidemiol. 2002;156:871–81.

    Article  PubMed  Google Scholar 

  15. Daviglus ML, Talavera GA, Avilés-Santa M, et al. Prevalence of major cardiovascular risk factors and cardiovascular diseases among Hispanic/Latino individuals of diverse backgrounds in the United States. JAMA. 2012;308:1775–84. This paper not only describes the epidemiology of risk factors in Hispanics/Latinos but also highlights the considerable heterogeneity in this population.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  16. Kurian AK, Cardarelli KM. Racial and ethnic differences in cardiovascular disease risk factors: a systematic review. Ethn Dis. 2007;17:143–52.

    PubMed  Google Scholar 

  17. Mensah GA, Mokdad AH, Ford ES, Greenlund KJ, Croft JB. State of disparities in cardiovascular health in the United States. Circulation. 2005;111:1233–41.

    Article  PubMed  Google Scholar 

  18. Jose PO, Frank ATH, Kapphahn KI, Goldstein BA, Eggleston K, Hastings KG, et al. Cardiovascular disease mortality in Asian Americans. J Am Coll Cardiol. 2014;64:2486–94. This study used a very large sample (10,442,034) to examine mortality rates in Asian Americans. The authors also detailed the significant differences between the extremely different groups which are lumped into the “Asian” classification.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Sorlie PD, Backlund E, Johnson NJ, Rogot E. Mortality by Hispanic status in the United States. JAMA. 1993;270:2464–8.

    Article  CAS  PubMed  Google Scholar 

  20. Cortes-Bergoderi M, Goel K, Murad MH, Allison T, Somers VK, Erwin PJ, et al. Cardiovascular mortality in Hispanics compared to non-Hispanic whites: a systematic review and meta-analysis of the Hispanic paradox. Eur J Intern Med. 2013;24:791–9.

    Article  PubMed  Google Scholar 

  21. Abraído-Lanza AF, Dohrenwend BP, Ng-Mak DS, Turner JB. The Latino mortality paradox: a test of the “salmon bias” and healthy migrant hypotheses. Am J Public Health. 1999;89:1543–8.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Ruiz JM, Steffen P, Smith TB. Hispanic mortality paradox: a systematic review and meta-analysis of the longitudinal literature. Am J Public Health. 2013;103:e52–60.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Medina-Inojosa J, Jean N, Cortes-Bergoderi M, Lopez-Jimenez F. The Hispanic paradox in cardiovascular disease and total mortality. Prog Cardiovasc Dis. 2014;57:286–92.

    Article  PubMed  Google Scholar 

  24. Caleyachetty R, Echouffo-Tcheugui JB, Muennig P, Zhu W, Muntner P, Shimbo D. Association between cumulative social risk and ideal cardiovascular health in US adults: NHANES 1999–2006. Int J Cardiol. 2015;191:296–300.

    Article  PubMed  Google Scholar 

  25. Folsom AR, Yatsuya H, Nettleton JA, Lutsey PL, Cushman M, Rosamond WD, et al. Community prevalence of ideal cardiovascular health, by the American Heart Association definition, and relationship with cardiovascular disease incidence. J Am Coll Cardiol. 2011;57:1690–6.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Dong C, Rundek T, Wright CB, Anwar Z, Elkind MSV, Sacco RL. Ideal cardiovascular health predicts lower risks of myocardial infarction, stroke, and vascular death across whites, blacks, and hispanics: the northern Manhattan study. Circulation. 2012;125:2975–84.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Rodriguez CJ. Disparities in ideal cardiovascular health: a challenge or an opportunity? Circulation. 2012;125:2963–4.

    Article  PubMed Central  PubMed  Google Scholar 

  28. Kwagyan J, Retta TM, Ketete M, Bettencourt CN, Maqbool AR, Xu S, et al. Obesity and cardiovascular diseases in a high-risk population: evidence-based approach to CHD risk reduction. Ethn Dis. 2015;25:208–13.

    PubMed Central  PubMed  Google Scholar 

  29. Goff DC, Bertoni AG, Kramer H, Bonds D, Blumenthal RS, Tsai MY, et al. Dyslipidemia prevalence, treatment, and control in the Multi-Ethnic Study of Atherosclerosis (MESA) gender, ethnicity, and coronary artery calcium. Circulation. 2006;113:647–56.

    Article  CAS  PubMed  Google Scholar 

  30. Bennet A, Di Angelantonio E, Erqou S, Eiriksdottir G, Sigurdsson G, Woodward M, et al. Lipoprotein(a) levels and risk of future coronary heart disease: large-scale prospective data. Arch Intern Med. 2008;168:598–608.

    Article  CAS  PubMed  Google Scholar 

  31. Virani SS, Brautbar A, Davis BC, Nambi V, Hoogeveen RC, Sharrett AR, et al. Associations between lipoprotein(a) levels and cardiovascular outcomes in black and white subjects: the Atherosclerosis Risk in Communities (ARIC) Study. Circulation. 2012;125:241–9.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  32. Guan W, Cao J, Steffen BT, Post WS, Stein JH, Tattersall MC, et al. Race is a key variable in assigning lipoprotein(a) cutoff values for coronary heart disease risk assessment: the Multi-Ethnic Study of Atherosclerosis. Arterioscler Thromb Vasc Biol. 2015;35:996–1001.

    Article  CAS  PubMed  Google Scholar 

  33. Daviglus ML, Pirzada A, Talavera GA. Cardiovascular disease risk factors in the Hispanic/Latino population: lessons from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Prog Cardiovasc Dis. 2014;57:230–6.

    Article  PubMed  Google Scholar 

  34. Rodriguez CJ, Cai J, Swett K, González HM, Talavera GA, Wruck LM, et al. High cholesterol awareness, treatment, and control among Hispanic/Latinos: results from the Hispanic Community Health Study/Study of Latinos. J Am Heart Assoc. 2015;4:e001867.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Kershaw KN, Osypuk TL, Do DP, Chavez PJD, Roux AVD. Neighborhood-level racial/ethnic residential segregation and incident cardiovascular disease the Multi-Ethnic Study of Atherosclerosis. Circulation. 2015;131:141–8. This study goes beyond the usual examination of non-traditional risk factors and uses neighborhood segregation as an independent variable for cardiovascular disease.

    Article  PubMed Central  PubMed  Google Scholar 

  36. NHANES - National Health and Nutrition Examination Survey Homepage [Internet]. [cited 2015 Aug 13]. Available from: http://www.cdc.gov/nchs/nhanes.htm.

  37. de Souza RJ, Anand SS. Cardiovascular disease in Asian Americans: unmasking heterogeneity∗. J Am Coll Cardiol. 2014;64:2495–7.

    Article  PubMed  Google Scholar 

  38. Yeboah J, McClelland RL, Polonsky TS, et al. Comparison of novel risk markers for improvement in cardiovascular risk assessment in intermediate-risk individuals. JAMA. 2012;308:788–95.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  39. Bild DE. Ethnic differences in coronary calcification: the Multi-Ethnic Study of Atherosclerosis (MESA). Circulation. 2005;111:1313–20.

    Article  PubMed  Google Scholar 

  40. McClelland RL, Chung H, Detrano R, Post W, Kronmal RA. Distribution of coronary artery calcium by race, gender, and age: results from the Multi-Ethnic Study of Atherosclerosis (MESA). Circulation. 2006;113:30–7.

    Article  PubMed  Google Scholar 

  41. Alluri K, McEvoy JW, Dardari ZA, Jones SR, Nasir K, Blankstein R, et al. Distribution and burden of newly detected coronary artery calcium: results from the Multi-Ethnic Study of Atherosclerosis. J Cardiovasc Comput Tomogr. 2015;9:337–44.e1. This study uses a relatively new risk factor and describes disease patterns by race.

    Article  PubMed  Google Scholar 

  42. Will JC, Yuan K, Ford E. National trends in the prevalence and medical history of angina: 1988 to 2012. Circ Cardiovasc Qual Outcomes. 2014;7:407–13.

    Article  PubMed Central  PubMed  Google Scholar 

  43. McKee MM, Winters PC, Fiscella K. Low education as a risk factor for undiagnosed angina. J Am Board Fam Med. 2012;25:416–21.

    Article  PubMed Central  PubMed  Google Scholar 

  44. Povsic TJ, Broderick S, Anstrom KJ, Shaw LK, Ohman EM, Eisenstein EL, et al. Predictors of long‐term clinical endpoints in patients with refractory angina. J Am Heart Assoc Cardiovasc Cerebrovasc Dis [Internet]. 2015, 4. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4345862/.

  45. Ford ES, Giles WH. Changes in prevalence of nonfatal coronary heart disease in the United States from 1971–1994. Ethn Dis. 2003;13:85–93.

    PubMed  Google Scholar 

  46. Cohen MG, Roe MT, Mulgund J, Peterson ED, Sonel AF, Menon V, et al. Clinical characteristics, process of care, and outcomes of Hispanic patients presenting with non-ST-segment elevation acute coronary syndromes: results from Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines (CRUSADE). Am Heart J. 2006;152:110–7.

    Article  PubMed  Google Scholar 

  47. Hayes DK, Greenlund KJ, Denny CH, Neyer JR, Croft JB, Keenan NL. Racial/ethnic and socioeconomic disparities in health-related quality of life among people with coronary heart disease, 2007. Prev Chronic Dis. 2011;8:A78.

    PubMed Central  PubMed  Google Scholar 

  48. Deshmukh M, Joseph MA, Verdecias N, Malka ES, LaRosa JH. Acute coronary syndrome: factors affecting time to arrival in a diverse urban setting. J Community Health. 2011;36:895–902.

    Article  PubMed  Google Scholar 

  49. Gillespie CD, Wigington C, Hong Y, Centers for Disease Control and Prevention (CDC). Coronary heart disease and stroke deaths—United States, 2009. Morb Mortal Wkly Rep Surveill Summ. 2013;62 Suppl 3:157–60.

    Google Scholar 

  50. DeVon HA, Burke LA, Nelson H, Zerwic JJ, Riley B. Disparities in patients presenting to the emergency department with potential acute coronary syndrome: it matters if you are Black or White. Heart Lung J Acute Crit Care. 2014;43:270–7.

    Article  Google Scholar 

  51. Movahed MR, Khan MF, Hashemzadeh M, Hashemzadeh M. Age adjusted nationwide trends in the incidence of all cause and ST elevation myocardial infarction associated cardiogenic shock based on gender and race in the United States. Cardiovasc Revasc Med. 2015;16:2–5.

    Article  PubMed  Google Scholar 

  52. Tataris KL, Mercer MP, Govindarajan P. Prehospital aspirin administration for acute coronary syndrome (ACS) in the USA: an EMS quality assessment using the NEMSIS 2011 database. Emerg Med J EMJ 2015.

  53. Mathews R, Wang TY, Honeycutt E, Henry TD, Zettler M, Chang M, et al. Persistence with secondary prevention medications after acute myocardial infarction: insights from the TRANSLATE-ACS study. Am Heart J. 2015;170:62–9.

    Article  PubMed  Google Scholar 

  54. Cavender MA, Rassi AN, Fonarow GC, Cannon CP, Peacock WF, Laskey WK, et al. Relationship of race/ethnicity with door-to-balloon time and mortality in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction: findings from get with the guidelines—coronary artery disease. Clin Cardiol. 2013;36:749–56. This study highlights persistent disparities in an important benchmark of CHD treatment quality. Despite the residual disparity, improvement in quality metrics was observed in all groups studied.

    Article  PubMed  Google Scholar 

  55. Curtis JP, Herrin J, Bratzler DW, Bradley EH, Krumholz HM. Trends in race-based differences in door-to-balloon times. Arch Intern Med. 2010;170:992–3.

    Article  PubMed  Google Scholar 

  56. Dauerman HL, Bates ER, Kontos MC, Li S, Garvey JL, Henry TD, et al. Nationwide analysis of patients with ST-segment-elevation myocardial infarction transferred for primary percutaneous intervention findings from the American Heart Association Mission: Lifeline Program. Circ Cardiovasc Interv. 2015;8:e002450.

    Article  PubMed  Google Scholar 

  57. Ayanian JZ, Udvarhelyi IS, Gatsonis CA, Pashos CL, Epstein AM. Racial differences in the use of revascularization procedures after coronary angiography. JAMA. 1993;269:2642–6.

    Article  CAS  PubMed  Google Scholar 

  58. Whittle J, Conigliaro J, Good CB, Lofgren RP. Racial differences in the use of invasive cardiovascular procedures in the Department of Veterans Affairs Medical System. N Engl J Med. 1993;329:621–7.

    Article  CAS  PubMed  Google Scholar 

  59. Gaglia MA, Shavelle DM, Tun H, Bhatt J, Mehra A, Matthews RV, et al. African-American patients are less likely to receive drug-eluting stents during percutaneous coronary intervention. Cardiovasc Revasc Med Mol Interv. 2014;15:214–8. This is a recent study that highlights that there is still an impact of race on the decision to use DES which can extend beyond other markers of socioeconomic status.

    Article  Google Scholar 

  60. Batchelor WB, Ellis SG, Ormiston JA, Stone GW, Joshi AA, Wang H, et al. Racial differences in long-term outcomes after percutaneous coronary intervention with paclitaxel-eluting coronary stents. J Intervent Cardiol. 2013;26:49–57.

    Article  PubMed  Google Scholar 

  61. Cram P, Bayman L, Popescu I, Vaughan-Sarrazin MS. Racial disparities in revascularization rates among patients with similar insurance coverage. J Natl Med Assoc. 2009;101:1132–9.

    Article  PubMed  Google Scholar 

  62. Bhalla R, Yongue BG, Currie BP, Greenberg MA, Myrie-Weir J, DeFino M, et al. Improving primary percutaneous coronary intervention performance in an urban minority population using a quality improvement approach. Am J Med Qual. 2010;25:370–7.

    Article  PubMed  Google Scholar 

  63. Bangalore S, Gupta N, Guo Y, Feit F. Trend in the use of drug eluting stents in the United States: insight from over 8.1 million coronary interventions. Int J Cardiol. 2014;175:108–19.

    Article  PubMed  Google Scholar 

  64. Guzman LA, Li S, Wang TY, Daviglus ML, Exaire J, Rodriguez CJ, et al. Differences in treatment patterns and outcomes between Hispanics and non-Hispanic Whites treated for ST-segment elevation myocardial infarction: results from the NCDR ACTION Registry—GWTG. J Am Coll Cardiol. 2012;59:630–1.

    Article  PubMed Central  PubMed  Google Scholar 

  65. Olafiranye O, Vlachos H, Mulukutla SR, Marroquin OC, Selzer F, Kelsey SF, et al. Comparison of long-term safety and efficacy outcomes after drug-eluting and bare-metal stent use across racial groups: insights from NHLBI Dynamic Registry. Int J Cardiol. 2015;184:79–85. This study describes a significant difference in outcome by race after the usage of DES. Further work will be needed to determine the precise cause of this difference.

    Article  PubMed  Google Scholar 

  66. Becker ER, Rahimi A. Disparities in race/ethnicity and gender in in-hospital mortality rates for coronary artery bypass surgery patients. J Natl Med Assoc. 2006;98:1729–39.

    PubMed Central  PubMed  Google Scholar 

  67. Rangrass G, Ghaferi AA, Dimick JB. Explaining racial disparities in outcomes after cardiac surgery: the role of hospital quality. JAMA Surg. 2014;149:223–7. A large number of subjects (173,925) were used to provide convincing evidence that hospital quality is a major source of the disparities in outcomes between races. There is still a large fraction of the disparity in outcomes that remains unexplained.

    Article  PubMed  Google Scholar 

  68. Girotti ME, Shih T, Revels S, Dimick JB. Racial disparities in readmissions and site of care for major surgery. J Am Coll Surg. 2014;218:423–30.

    Article  PubMed  Google Scholar 

  69. Khera R, Vaughan-Sarrazin M, Rosenthal GE, Girotra S. Racial disparities in outcomes after cardiac surgery: the role of hospital quality. Curr Cardiol Rep. 2015;17:29.

    Article  PubMed  Google Scholar 

  70. Pollock B, Hamman BL, Sass DM, da Graca B, Grayburn PA, Filardo G. Effect of gender and race on operative mortality after isolated coronary artery bypass grafting. Am J Cardiol. 2015;115:614–8.

    Article  PubMed  Google Scholar 

  71. Tourdot BE, Conaway S, Niisuke K, Edelstein LC, Bray PF, Holinstat M. Mechanism of race-dependent platelet activation through the protease-activated receptor-4 and Gq signaling axis. Arterioscler Thromb Vasc Biol. 2014;34:2644–50.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  72. Bray PF, Mathias RA, Faraday N, Yanek LR, Fallin MD, Herrera-Galeano JE, et al. Heritability of platelet function in families with premature coronary artery disease. J Thromb Haemost. 2007;5:1617–23.

    Article  CAS  PubMed  Google Scholar 

  73. Edelstein LC, Simon LM, Montoya RT, Holinstat M, Chen ES, Bergeron A, et al. Racial difference in human platelet PAR4 reactivity reflects expression of PCTP and miR-376c. Nat Med [Internet]. 2013 [cited 2015 Sep 21];19. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3855898/.

  74. Carty CL, Keene KL, Cheng Y-C, Meschia JF, Chen W-M, Nalls M, et al. Meta-analysis of genome-wide association studies identifies genetic risk factors for stroke in African Americans. Stroke. 2015;46:2063–8.

    Article  CAS  PubMed  Google Scholar 

  75. Qayyum R, Becker LC, Becker DM, Faraday N, Yanek LR, Leal SM, et al. Genome-wide association study of platelet aggregation in African Americans. BMC Genet [Internet]. 2015 [cited 2015 Sep 21];16. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4448541/.

  76. Kang H-J, Clare RM, Gao R, Held C, Himmelmann A, James SK, et al. Ticagrelor versus clopidogrel in Asian patients with acute coronary syndrome: a retrospective analysis from the Platelet Inhibition and Patient Outcomes (PLATO) Trial. Am Heart J. 2015;169:899–905.e1.

    Article  CAS  PubMed  Google Scholar 

  77. Waksman R, Maya J, Angiolillo DJ, Carlson GF, Teng R, Caplan RJ, et al. Ticagrelor versus clopidogrel in black patients with stable coronary artery disease prospective, randomized, open-label, multiple-dose, crossover pilot study. Circ Cardiovasc Interv. 2015;8:e002232.

    Article  PubMed  Google Scholar 

  78. 13 M, 2013. Health coverage by race and ethnicity: the potential impact of the affordable care act [internet]. [cited 2015 Sep 13]. Available from: http://kff.org/disparities-policy/issue-brief/health-coverage-by-race-and-ethnicity-the-potential-impact-of-the-affordable-care-act/.

  79. Health Insurance Coverage and the Affordable Care Act [Internet]. ASPE. [cited 2015 Sep 13]. Available from: http://aspe.hhs.gov/pdf-document/health-insurance-coverage-and-affordable-care-act.

  80. Burke JF, Vijan S, Chekan LA, Makowiec TM, Thomas L, Morgenstern LB. Targeting high-risk employees may reduce cardiovascular racial disparities. Am J Manag Care. 2014;20:725–33.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Carlos J. Rodriguez.

Ethics declarations

Conflict of Interest

J. Adam Leigh and Manrique Alvarez declare that they have no conflict of interest. Carlos J. Rodriguez declares personal fees from Alnylam and non-financial support from AMGEN and Merck.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Coronary Heart Disease

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Leigh, J.A., Alvarez, M. & Rodriguez, C.J. Ethnic Minorities and Coronary Heart Disease: an Update and Future Directions. Curr Atheroscler Rep 18, 9 (2016). https://doi.org/10.1007/s11883-016-0559-4

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11883-016-0559-4

Keywords

Navigation