Gone are the days of one-size-fits-all treatment protocols in medicine. Yes, we’re all humans, and we mostly share similar bodies and health conditions, but there are differences of environment, genetics, and anatomy that have led to the rise of a more personalized medicine. Differences of gender, race, environment, socioeconomic status, lifestyle, and genetic predispositions can all influence a person’s health, including predisposition for disease. Research into how human differences can affect health has slowly grown so that now there are some clearly recognized risk factors that affect some groups more than others. The bulk of this research is recent enough that it hasn’t always fully trickled down to the general public or even into every corner of medicine. There’s much more to be done, but we know vastly more than we once did about men’s and women’s health concerns, how genetic predispositions for certain diseases can be more of a concern with some ethnic groups, and how specific concerns in health should be highlighted for different communities. Decisions about a testing regimen for a patient should also take into account their makeup. Precision Point Diagnostics as a functional testing lab has always been a champion of the movement toward personalized medicine. Today, in honor of MLK Day, we’d like to focus on particular health concerns that should be monitored by African Americans, and we’ll discuss the sort of testing that we offer that gives a more comprehensive look at the risk factors involved.
Heart Disease and Hypertension
Heart disease is still the number one cause of death for Americans. Although progress has been made, and rates of heart disease have improved since the 1970s, that improvement has come at a greater rate for Caucasians than it has for African Americans. Researchers have reported that African Americans have remained at a higher risk for heart disease than whites for the past 20 years. In 2019, African Americans were 30 percent more likely to die from heart disease than non-Hispanic whites. Although African American adults are 30 percent more likely to have high blood pressure, they are less likely than non-Hispanic whites to have their blood pressure under control.
One reason is lack of access to healthcare, but lack of adequate monitoring can also cause more severe outcomes. Early identification of high blood pressure and of a number of cardiac markers can decrease the chances of cardiac events, and lessen the severity of those events. The Precision Point Oxidized LDL with Lipids panel and Advanced Oxidative Stress Test together offer alternative markers that can more completely surveil some of the risk factors associated with heart disease. Oxidized LDL. Oxidized LDL is thought to play a key role in the inflammatory response in the arterial vessel wall. OxLDL is involved in the very early yet critical steps of atherogenesis, such as endothelial injury, expression of adhesion molecules, and leukocyte recruitment and retention, as well as foam cell and thrombus formation. A study found that plasma oxLDL was the strongest predictor of CHD events compared with a conventional lipoprotein profile and other traditional risk factors for CHD.
Strong medical and scientific evidence points to oxidative stress as an underlying contributing factor to heart disease. The Advanced Oxidative Stress profile measures total glutathione, reduced glutathione, F2-isoprostane, and 8-OH-2deoxyguanosine from whole blood and urine specimens. Aside from the links with inflammation that all of these markers have, F2-isoprostane can be a strong predictor of CHD.
The PPD Male and Female Wellness Profiles also assess a number of cardiometabolic markers: Ferritin, Fibrinogen, Homocysteine, Cholesterol, HDL, LDL, Triglycerides, CRP, and HbA1c.
Rates of Diabetes
- African American adults were 60% more likely than non-Hispanic white adults to be diagnosed with diabetes by a physician in 2018.
- In 2018, the prevalence of diabetes was 11.7% among non-Hispanic Black people and 7.5% among non-Hispanic white people.
Impacts of Diabetes
- In 2019, non-Hispanic blacks were twice as likely as non-Hispanic whites to die from diabetes.
- Non-Hispanic blacks were 2.5 times more likely to be hospitalized with diabetes and associated long-term complications than non-Hispanic whites in 2019.
- Non-Hispanic blacks were 3.2 times more likely to be diagnosed with end-stage renal disease compared to non-Hispanic whites in 2019.
Diabetes clearly is a problem in the African American community. Not only are rates higher, but the prognosis is worse. Aside from conducting standard tests to assess diabetic and prediabetic states, earlier predictors such as overall metabolic state including blood glucose levels can allow a practitioner to counsel a patient earlier. If a patient is found to be diabetic or pre-diabetic, then assessing kidney function as well as overall health through a comprehensive wellness profile might be advised. Precision Point offers both male and female wellness profiles that assess a range of markers to assess overall health, including insulin and eGFR (with values measured separately for African American and non-African American) to assess CKD, as well as a range of other markers assessing kidney function.
The incidence of cancer (those who are diagnosed with the disease) in the United States is highest in African-Americans. For most types of cancer, African Americans have the highest death rate and shortest survival of any racial/ethnic group in the United States. Black women are 41% more likely to die from breast cancer than White women. This statistic is even more striking because fewer Black women are diagnosed with breast cancer than White women. Cancer is still the number two killer in the United States, and although the gap between African American and non-African-American rates is narrowing, early detection still needs to be bolstered.
One somewhat surprising bit of research regarding cancer not very well known by the general public is the link between cancer and vitamin D levels. Vitamin D plays a crucial role in the body, including reducing inflammation, controlling cell growth, influencing neuromuscular and immune function, and glucose metabolism. Low levels of vitamin D have been associated with an increased risk of various types of cancer. For African Americans, studies have shown that they generally have lower levels of vitamin D in the blood. This is significant because research has found an inverse association between circulating vitamin D levels and incident breast cancer among self-identified Black/African American women. In fact, one study showed that 69.2% of African Americans had vitamin D levels below 20 ng/mL, which was significantly associated with breast cancer.
The Male and Female Wellness Profiles from Precision Point Diagnostics include vitamin D analysis among the many other analytes measured. Routine measurement of vitamin D levels could potentially decrease cancer risks for African Americans in several ways:
- Early Detection of Deficiency: Regular testing can help identify vitamin D deficiency early, allowing for timely intervention.
- Guiding Supplementation: Once a deficiency is identified, healthcare providers can recommend appropriate vitamin D supplementation. This can help improve vitamin D status. One study found that those who took 2,000 international units (IU) of vitamin D each day for an average of 5.3 years were nearly 20% less likely to have an advanced cancer.
- Monitoring Treatment: Regular measurement can also help monitor the effectiveness of supplementation and ensure that vitamin D levels are being adequately restored.
- Reducing Cancer Risk: High levels of vitamin D have been associated with a 20% lower relative risk of cancer in both men and women compared with low vitamin D levels. Therefore, maintaining adequate vitamin D levels through routine measurement and supplementation could potentially reduce cancer risk.
Health disparities research has advanced quite a bit over the last few decades, and of course there is much more to be done. Specific studies into African American health incidences and outcomes were much neglected until relatively recently. More recent data certainly suggests some actions that can be taken in terms of testing and monitoring, although that of course doesn’t tell the whole story. The suggestions in this newsletter are by no means complete but hopefully will have some value in terms of African American patients.