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Heart Disease - End Stage Organ Disease

Diabetes

The incidence of endstage renal disease resulting from diabetes is 2.6fold higher in blacks than in whites, especially among type II diabetics. Insulin is atherogenic via several metabolic pathways. It has been suggested that, in an individual who is insulin resistant, the body attempts to maintain normal glucose tolerance by augmenting the secretion of insulin, causing hyperinsulinemia and atherosclerosis. It also has been suggested that the hyperinsulinemia and insulin resistance commonly observed in type II diabetes might increase the risk of renal hypertension owing to salt and water retention and increased microvascular reactivity to angiotensin II and norepinephrine. Blacks appear to have an increased risk for both diabetic and hypertensive renal disease.

HEART FAILURE AND CHD

Numerous studies have documented the increased prevalence of congestive heart failure in blacks. The reasons for the prominence of heart failure in the spectrum of CHD in blacks may be related to comorbid conditions such as cardiomyopathies (i.e., primary myocardial diseases) which, when combined with risk factors common in blacks, lead to significant ventricular dysfunction.
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