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Chronic Exposure to Everyday Discrimination and Coronary Artery Calcification in African-American Women: The SWAN Heart Study

Lewis, Tené T. PhD; Everson-Rose, Susan A. PhD; Powell, Lynda H. PhD; Matthews, Karen A. PhD; Brown, Charlotte PhD; Karavolos, Kelly MA; Sutton-Tyrrell, Kim DrPH; Jacobs, Elizabeth MD; Wesley, Deidre MPA

doi: 10.1097/01.psy.0000221360.94700.16
Original Articles

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.

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.

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.).

Clinical Center: Rush University, Rush University Medical Center, Chicago, IL: Lynda Powell, PI, and the University of Pittsburgh, Pittsburgh, PA: Karen Matthews, PI; NIH Program Office: National Institute on Aging, Bethesda, MD: Marcia Ory 1994–2001; Sherry Sherman 1994–present; National Institute of Nursing Research, Bethesda, MD: Program Officers, Central Laboratory: University of Michigan, Ann Arbor: Daniel McConnell (Central Ligand Assay Satellite Services); Coordinating Center: New England Research Institutes, Watertown, MA: Sonja McKinlay, PI 1995–2001; University of Pittsburgh, Pittsburgh, PA: Kim Sutton-Tyrrell, PI, 2001–present.

Steering Committee: Chris Gallagher, Chair, Susan Johnson, Chair.

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@rush.edu

Received for publication August 12, 2005; revision received December 21, 2005.

Copyright © 2006 by American Psychosomatic Society
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