21
Î Increased ASCVD risk is associated with geographic region, genetics,
culture (shared values, beliefs, customs, and learned behavior) and
the social determinants of health (low income, lack of access to, or
inadequate, health insurance, and low educational attainment) for all
of which "race" is a crude proxy.
• Broad policy areas for addressing racial/ethnic health care disparities include
raising public and provider awareness of racial/ethnic disparities in care and
outcomes, expanding health insurance coverage, improving capacity and number
of providers in underserved communities, and increasing the knowledge base on
causes and interventions to reduce disparities.
Î The lifespan of patients with HIV infection and suppressed viral
replication now approaches that of the general population. This
prolonged survival is associated with an increased prevalence
of co-morbidities, including CVD, presumably due in part to the
inflammation, immune activation, and immune senescence associated
with this viral infection. Results from observational studies support an
increased CVD risk in the HIV population. However there is a paucity of
data linking cardiovascular outcomes with lipid goals and no validated
risk stratification schemes for this patient population.
Î CVD has been found to be elevated across the spectrum of
inflammatory diseases, including temporal arteritis, with perhaps the
highest risk among young women with systemic lupus erythematosus.
Currently no validated strategy exists in the United States that
can integrate the burden of chronic inflammation with traditional
risk factors to quantify cardiovascular risk in these patients. This
discussion focuses on rheumatoid arthritis because it is the most
common inflammatory disease with the most data available on
cardiovascular risk.
Special Populations
