Social determinants of health contribute to higher CVD mortality rates in Black persons

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A study of more than 50,000 US adults suggests that social determinants of health are a major contributing factor to higher mortality rates from cardiovascular disease (CVD) in Black individuals compared to Whites.  The findings are published in Annals of Internal Medicine.

CVD mortality is persistently higher in the Black population than in other racial/ethnic groups in the United States. Social determinants of health (SDOHs) have been associated with CVD risk factors and CVD events and mortality in epidemiologic studies. However, data are scarce on the complex relationship of social, behavioral, and metabolic risk factors with racial differences in CVD mortality in a large, nationally representative sample in the U.S. population.

Researchers from Tulane University conducted an observational study of 50,808 persons aged 20 years and older to examine the degree to which social, behavioral, and metabolic risk factors are associated with CVD mortality and the extent to which racial differences in CVD mortality persist after these factors are accounted for. The authors found that age- and sex-adjusted CVD mortality was significantly higher in Black participants than White participants. They also found that in addition to behavioral and metabolic risk factors, several social factors—including unemployment, lower family income, food insecurity, not owning a home, and not being married or living with a partner—were significantly associated with CVD mortality independently of established behavioral and metabolic risk factors. Black–White differences in CVD mortality were diminished after adjustment for behavioral and metabolic risk factors and entirely dissipated after adjustment for social factors. According to the authors, future research is warranted to understand the underlying mechanisms of SDOHs on CVD mortality and develop novel interventions for reducing CVD mortality in populations, especially in Black persons.

2. Low dose steroid use not associated with substantial weight gain or hypertension in patients with rheumatoid arthritis

FREE Summary:

An analysis of randomized controlled trials has found that the use of low-dose glucocorticoids was not associated with substantial weight gain or hypertension in patients being treated for rheumatoid arthritis. The analysis is published in Annals of Internal Medicine.

Glucocorticoids are often used in the management of rheumatoid arthritis (RA). Weight gain and hypertension are well known adverse effects of treatment with high-dose glucocorticoids. However, little is known about the adverse effects of low-dose steroids, which are commonly used to treat RA.

Researchers from Charite – Universitätsmedizin Berlin, Berlin, Germany conducted a pooled analysis of five randomized controlled trials with 2-year interventions to evaluate the effects of low-dose glucocorticoid treatment in RA. The researchers found that use of low-dose glucocorticoids was associated with a 1.1 kilogram weight increase compared to a control. They observed no significant differences in blood pressure between groups.

An accompanying editorial by David Fernandez, MD, PhD of the Hospital for Special Surgery, New York, New York says that the risks of low-dose glucocorticoid therapy may be smaller and more manageable than they may appear based on observational studies. He notes that the 2-year timespan of the studies may not fully evaluate the effect of weight gain and hypertension because those effects may manifest over decades. However, the findings provide a more quantifiable assessment of the potential adverse effects of steroid therapy than had existed previously and will be helpful to providers and patients as they decide on the relative risks and benefits of glucocorticoids as part of their therapy plan.


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