Cardiovascular Risk and Psychosocial Factors in Blacks: A Meta-Analysis of Individual Participant Data

Abstract

Background. Blacks have higher age-adjusted mortality rates than any other ethnic groups; however, the reasons for these disparities are still largely unknown. Many have theorized that psychosocial risk factors, such as depressive symptoms, hostility, discrimination and job strain, may contribute to CVD risk; however, few studies have had a large enough sample size to investigate to what extent psychosocial factors predict cardiovascular risk in Blacks or whether other factors like age or sex modify these effects.

Methods. This study pooled individual-level data from three population-based cohort studies (the Coronary Artery Risk Development in Young Adults, the Multi-Ethnic Study of Atherosclerosis, and Jackson Heart Study) to investigate the effect of psychosocial factors on hypertension (Aim 1), diabetes (Aim 2), and incident cardiovascular disease (Aim 3) in Blacks. We estimated the cross-sectional and longitudinal relationship between psychosocial risk factors and cardiovascular risk using Poisson and Cox regression, and we tested for heterogeneity of effect using interaction terms.

Results. One standard deviation increase in depressive symptoms were associated with a 14% increase in the rate of hypertension (CI: 1.08, 1.20), an 8% increase in the rate of diabetes (CI: 1.00, 1.16), and a 13% increase in the rate of CVD (CI: 1.03, 1.25). One standard deviation increase in hostility was associated with 15% increase in incident hypertension in the pooled sample (CI: 1.09, 1.21), and effects of hostility on diabetes and CVD were noted within specific cohorts and age groups. Discrimination is associated with a 9% increase in incident hypertension in Black men (CI: 1.00, 1.18), but not in Black women, and the effects of discrimination tended to be strongest in the MESA cohort. Finally, we observed that job strain is associated with a 27% increase in the rate of hypertension in the pooled sample (CI: 1.07, 1.50), and effects of job strain on diabetes and CVD were noted within specific cohorts and geographic regions.

Conclusions: Depression poses a threat to cardiovascular health in Blacks, and the integration of mental health services is a promising strategy to reduce the incidence of CVD in Blacks. Given the variability of effects among other psychosocial characteristics, though, it does not appear that these risk factors explain systematic differences in the CVD risk profiles in Blacks. Particular attention to macrosocial constraints on mental health and healthy lifestyles will enable researchers to intervene on the broader social and environmental context which perpetuate racial disparities in cardiovascular disease.