Some of the excess CVD mortality in AAs can be attributed to a higher prevalence of modifiable risk factors and their cardiovascular consequences, particulariy hypertension. There is a 62.9% prevalence of hypertension in the JHS cohort (Wyatt et. al, 2008). Hypertensive target organ-damage is also seen more frequently, is typically more severe, and occurs at younger ages in AAs. In particular, renal failure and left ventricular hypertrophy (LVH) are more common in AA than EA hypertensive individuals at comparable levels of blood pressure (Klag, 1997). Other risk factors more common in AAs than EAs include type 2 diabetes mellitus, high density lipoprotein (HDL) cholesterol, increased lipoprotein (Lp), and obesity (in women). While biologic and genetic influences on CVD risk may vary by ethnicity, they interact with and are modified by environmental variables including cultural, psychosocial, and economic issues. At least half the excess risk in AAs is unexplained (Jones et al., 2002. Relationships exist between disease states and obesity and body composition, including body mass index (BMI), total body weight, waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio, and body surface area (Ochs-Balcom, 2006). Koziel (2007) reported that lung function was related to Increased skin-fold thicknesses and subcutaneous and visceral fat deposits and that subcutaneous fat in the upper thorax affected certain organ function more than other body composition measures, including visceral and subcutaneous abdominal fat. In addition, about half of all causes of mortality in the U.S. are linked to social and behavioral factors, like diet and sedentary life-style (lOM, 2000).
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