Elsevier

Progress in Cardiovascular Diseases

Volume 71, March–April 2022, Pages 11-19
Progress in Cardiovascular Diseases

Racial and ethnic disparities in cardiometabolic disease and COVID-19 outcomes in White, Black/African American, and Latinx populations: Physiological underpinnings

https://doi.org/10.1016/j.pcad.2022.04.005Get rights and content

Abstract

Coronavirus disease 2019 (COVID-19) is a highly contagious respiratory illness caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) that began spreading globally in late 2019. While most cases of COVID-19 present with mild to moderate symptoms, COVID-19 was the third leading cause of mortality in the United States in 2020 and 2021. Though COVID-19 affects individuals of all races and ethnicities, non-Hispanic Black and Hispanic/Latinx populations are facing an inequitable burden of COVID-19 characterized by an increased risk for hospitalization and mortality. Importantly, non-Hispanic Black and Hispanic/Latinx adults have also faced a greater risk of non-COVID-19-related mortality (e.g., from cardiovascular disease/CVD) during the pandemic. Contributors to the racial disparities in morbidity and mortality during the pandemic are multi-factorial as we discuss in our companion article on social determinants of health. However, profound racial variation in the prevalence of CVD and metabolic diseases may serve as a key driver of worse COVID-19-related and non-COVID-19-related health outcomes among racial and ethnic minority groups. Within this review, we provide data emphasizing the inequitable burden of CVD and metabolic diseases among non-Hispanic Black and Hispanic/Latinx populations. We also discuss the pathophysiology of these conditions, with a focus on how aberrant physiological alterations in the context of CVD and metabolic diseases manifest to increase susceptibility to severe COVID-19.

Keywords

SARS-CoV-2
Cardiovascular disease
Metabolic disease
Health disparities
Obesity

Abbreviations

ACE2
angiotensin converting enzyme 2
BMI
body mass index
BP
blood pressure
CDC
Centers for Disease Control and Prevention
cf-PWV
carotid femoral pulse wave velocity
CHD
coronary heart disease
COVID-19
coronavirus disease 2019
CKD
chronic kidney disease
CV
cardiovascular
CVD
cardiovascular disease
FMD
flow-mediated dilation
HF
heart failure
HRV
heart rate variability
ICU
intensive care unit
MESA
Multi-Ethnic Study of Atherosclerosis
MSNA
muscle sympathetic nerve activity
NHANES
National Health and Nutrition Examination Survey
RR
relative risk or risk ratio
SARS-CoV-2
severe acute respiratory syndrome coronavirus-2
T2D
type 2 diabetes
US
United States

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1

These authors contributed equally to this work.

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