PILOT A: Cardiovascular disease (CVD) affects 12 million people in the United States. Although CVD has decreased over the years, these rates have varied by race and ethnicity, remaining the primary killer of all adults. Evidence exists of the inequalities in the prevention, treatment, and control of CVD. CVDs account for more than one third of the differences in the life expectancy between African Americans and whites. A proposed framework for action to eliminate CVD disparities by Dr. Mensah of the Centers for Disease Control and Prevention provides ten focal areas, with access to care and quality of care as the two areas that have the most to contribute in eliminating disparities. However, the content and quality of care may differ as a result of physician bias, overt or perceived discrimination, and gender. Perceived discrimination and lack of social support increases psychosocial stress, which has been associated with adverse outcomes in CVD. Nonetheless, the pathophysiology that links psychosocial stress with adverse CVD outcomes has been suggested, but is largely unknown. For example, evidence suggests that psychosocial factors, such as work stress and depression, contribute to an increased level of inflammatory markers (ex: C-reactive protein) in the bloodstream. Studies have found that certain experiences of discrimination may contribute to elevated blood pressures, suggesting a physiologic response. No studies have specifically investigated if experiencing perceived discrimination, low social support, and poor sense of control is associated with higher levels of inflammatory markers and elevated calcium scores (determined by electron beam computed tomography), both of which are independent risk factors for cardiovascular disease.
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