CRYSTAL CITY, Va.(EGMN)–A combination of traditional and nontraditional risk factors, such as racial discrimination and weight-based discrimination, are associated with higher risk of cardiovascular disease in African Americans, according to data from the Jackson Heart Study.

For example, African Americans who reported more discrimination over time had higher levels of hypertension than those who reported less discrimination, said Mario Sims, Ph.D., an associate professor of medicine at the University of Mississippi. Dr. Sims presented some of his findings at the annual meeting of the International Society on Hypertension in Blacks.

The relationship between psychosocial factors and cardiovascular disease (CVD) has been well established, but studies involving large cohorts of African Americans are limited, said Dr. Sims.

“I think that, for clinicians, our research should enable them to understand their patients’ illnesses in the totality of the environment in which the patients live—the extent to which stress, discrimination, and social status impact their likelihood of developing heart disease,” he said in an interview.

“With this information, clinicians should be able to develop interventions that would mitigate the effects of stress on heart disease, as well as treat their patients with more cultural competence,” he said.

To examine the role of nontraditional psychosocial risk factors and standard risk factors for CVD in African Americans, Dr. Sims and colleagues reviewed data from the Jackson Heart Study, a single-site, longitudinal cohort study of more than 5,000 African Americans who were enrolled between 2000 and 2004. As part of the study, participants report for clinical visits and interviews approximately every 3-4 years. Measures of psychosocial risk factors include socioeconomic status and perceived stress and discrimination.

Dr. Sims highlighted some of his findings at the annual meeting of the International Society on Hypertension in Blacks.

• Obesity and discrimination. In a subset of 4,960 participants who reported discrimination (3,124 women and 1,816 men), those who were obese reported higher levels of both racial and nonracial discrimination than their normal-weight peers.

• Hypertension and discrimination. The prevalence of hypertension was significantly higher among women who were in the highest quartile of reported lifetime discrimination compared with the lowest quartile (prevalence ratio of 1.10, 95% CI 1.02, 1.2). In men, the prevalence of hypertension was highest among those who reported being “very” stressed by discrimination, compared with those who reported no stress (prevalence ratio of 1.12, 95% CI 1.0, 1.3).

• Diabetes and socioeconomic status. Low-income or middle-income men were significantly more likely to have diabetes, compared with high-income men. Low-income women were significantly more likely to have diabetes, compared with high-income women, and in one model, diabetes was significantly more likely among middle-income women, compared with high-income women, Dr. Sims said.

“Our findings underscore the need to examine nontraditional risk factors in the etiology of CVD in a large cohort of African Americans, Dr. Sims noted. “Our findings also highlight the heterogeneity among African Americans in the Jackson Heart Study,” he said.

More research is needed on possible links between discrimination and additional CVD risk factors, as well as links between discrimination and subclinical disease, and between socioeconomic status and other risk factors such as hypertension, Dr. Sims said.

Some challenges and limitations of researching nontraditional disease risk factors include developing the appropriate psychosocial measures that capture the phenomenon to be studied in a specific population, he added.

“Our measures may capture something different in a population of African Americans in Chicago or Los Angeles because of the historical, environmental, and contextual differences in those areas. In other words, the generalizability of the nontraditional risk factors remains a constant limitation in our research,” he explained.

Dr. Sims said he had no financial conflicts to disclose.