Ethnic Disparities in Cardiovascular Diseases: A Population-Based Analysis

    • September 30, 2008

The Problem: Inflammation is one of the critical determinants of cardiovascular disease. But does the risk of developing this particular determinant vary according to race and ethnicity? The answer could be a key to the prevention and treatment of cardiovascular disease in African Americans, who have the highest death rate from heart disease of any population group.

Grantee Background: As a school girl in Guyana, Michelle Asha Albert, MD, MPH, considered becoming an actuary. She loved math, her father studied actuarial science and her mother had a master’s degree in economics. But she also loved science and history, and ultimately decided that an important component of growing up in the Third World raised by her grandparents in a working class household was to understand the impact morbidity has had on her country and its people. “My interest in medicine developed in a social context—the desire to make change at a population level,” Albert says.

In her teens, Albert joined extended family in the United States, and at age 16 entered Haverford College in Haverford, Pa., followed by medical school at the University of Rochester, New York, and an internship and residency at Columbia University Presbyterian Medical Center, New York, where she was chief resident, 1997–1998.

An initial interest in cardiac surgery gave way to cardiology. “I like to build a story, to go through a deductive process—cardiology is very much like that,” Albert says. “If you can deduce things, and understand the basic mechanisms, it is easier to put diagnosis and disease processes together.” Because cardiovascular disease is the number one killer, it has a large impact on a host of social issues that concern her. “And the specialty is versatile—it involves procedures, research, bedside clinical work, and I like them all,” says Albert. “As a surgeon, I didn’t see how I would have the time to devote to the whole social aspect of medicine. Surgeons don’t spend much time out of the operating room, and that wouldn’t have worked well for me.”

A board-certified internist and cardiologist, Albert chose to work at Boston’s Brigham and Women’s Hospital, a teaching affiliate of Harvard Medical School, to study with Paul M. Ridker, M.D., M.P.H., an expert on inflammation as a risk factor in cardiovascular disease and on risk predictors for inflammation in various populations and race/ethnic groups. In the last decade or so, the thinking about the cause of heart attacks has been revolutionized, Albert explains. Instead of just blaming cholesterol blockage as the cause of coronary disease, experts now know that inflammation in the vessel wall results in a cholesterol deposit becoming unstable and rupturing, resulting in a heart attack. “A lot has been documented due to research here at Brigham and elsewhere, using inflammatory markers that can be used to predict future cardiovascular disease,” Albert says.

From 2001-2005, Albert used a grant from the Robert Wood Johnson Foundation’s Harold Amos Medical Faculty Development Program to conduct a population-based analysis of cardiovascular thrombosis. While there are many markers of inflammation, Albert focused on C-reactive protein levels in blood samples as key to predicting future cardiovascular disease in different populations. As she says, the research showed that, “One of the major paths to determinants of cardiovascular events—inflammation—is different by race, ethnicity and in part, may be reflected in the statistics of higher mortality in certain races.”

As a scholar in the Harold Amos Program, Albert also conducted one of the first randomized studies to look at reducing inflammation through the use of drugs called statins. “Did the drug reduce the level of inflammation, measured by the C-reactive protein?” says Albert. “We found that it did.”

Albert is grateful to the RWJF program for the luxury of time to do research without the burden of clinical responsibilities. “I’m very active clinically, but if you are not able to bring in sufficient grant money to help pay for salary and research, you have to put that time into clinical work,” she says. “As a RWJF scholar, I had four years of protected time to focus on research. It offered me a lot of peace of mind.”

Today, Albert’s primary research continues to focus on the molecular and genetic epidemiology of hemostasis, thrombosis and inflammation. Albert credits the research she conducted under the Harold Amos Program with intensifying her commitment to understanding the role of race and ethnicity in cardiovascular outcomes, and to her interest in the links between chronic stress and heart disease. “This may sound corny, but my goal is to one day have everyone of different ethnic and racial backgrounds be on an even playing field for health outcomes,” she says. “I’d like to see the gap in mortality for cardiovascular disease be eliminated.”

RWJF Perspective: The Harold Amos Medical Faculty Development Program is a four-year postdoctoral fellowship launched by RWJF in 1983. Its purpose is to increase the number of faculty from minority and other historically disadvantaged backgrounds who will achieve senior rank in academic medicine and dentistry, which will enable them to foster the development of succeeding classes of such physicians and dentists.

RWJF’s objective is to increase diversity in the medical and dental professions and, as a consequence, improve the health care received by our nation’s underserved populations. An applicant’s commitment to eliminating health disparities is among the program’s selection criteria.

“Ultimately,” says RWJF senior program officer David M. Krol, MD, MPH, “we would like to see these individuals from disadvantaged backgrounds becoming full professors at prestigious institutions, putting out important, valuable work, looking at a variety of different issues—including how to decrease the disparities between rich and poor, majority and minority—while climbing the academic ladder.”

Michelle Asha Albert is one of more than 180 Amos Program alumni in academic medicine today. Her career and research exemplify the academic achievement and professional contributions that the program was designed to stimulate.

“The measure of the success of the program is the success of the individuals” who participate in it, says Krol.