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From the Department of Preventive Medicine (T.T.L., S.A.E.-R., L.H.P., E.J., K.K., D.W.), Department of Behavioral Sciences (L.H.P., S.A.E.-R.), and the Institute for Healthy Aging (S.A.E.-R.), Rush University Medical Center, Chicago, Illinois; Department of Medicine, Cook County Hospital, Chicago, Illinois (E.J.); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (K.A.M., C.B.); Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania (K.A.M., K.S.-T.).
Address correspondence and reprint requests to Tené T. Lewis, PhD, Department of Preventive Medicine, Rush University Medical Center, 1700 W. Van Buren, Suite 470. Chicago, IL 60612. E-mail: tene_lewis{at}rush.edu
Background: Emerging evidence suggests that exposure to discrimination may be associated with atherosclerosis in African-American women, although research in this area focused on short-term rather than chronic exposure to discriminatory events.
Methods: We examined the relationship between chronic exposure to multiple types of discrimination (self-reported and averaged over 5 years) and coronary artery calcification (CAC) in a sample of 181 middle-aged African-American women. Discrimination was assessed at each time point, and the presence/absence of CAC was assessed at the fifth annual follow-up examination by electron beam tomography. We hypothesized that chronic discrimination would be more strongly associated with CAC than recent discrimination and that racial/ethnic discrimination would be more strongly associated with CAC than other types of discrimination.
Results: Chronic exposure to discrimination was significantly associated with the presence of CAC in unadjusted logistic regression analyses (p = .007) and after adjustment for demographics (p = .01), standard cardiovascular risk factors (p = .02), and Body Mass Index (BMI) (p = .05). In contrast, recent discrimination was only marginally associated with the presence of CAC in both unadjusted (p = .06) and fully adjusted logistic regression models (p = .08). Persistent exposure to racial/ethnic discrimination was not more strongly associated with CAC compared with other types of discrimination in either unadjusted or adjusted models.
Conclusion: Chronic exposure to discrimination may be an important risk factor for early coronary calcification in African-American women. This association appears to be driven by exposure to discrimination from multiple sources, rather than exposure to racial/ethnic discrimination alone.
Key Words: discrimination • chronic stress • atherosclerosis • coronary calcium • African-American • women
Abbreviations: CVD = cardiovascular disease; CAC = coronary artery calcification; SWAN = Study of Women’s Health Across the Nation; EBT = electron beam tomographic; CES-D = Center for Epidemiological Studies Depression; BMI = body mass index; FRS = Framingham Risk score; HDL-c = high density lipoprotein cholesterol; CRP = C-reactive protein; OR = odds ratio; CI = confidence interval; IMT = intima-media thickness.
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