https://doi.org/10.1177/1474515117741892 European Journal of Cardiovascular Nursing 2018, Vol. 17(4) 294–296 © The European Society of Cardiology 2017 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1474515117741892 journals.sagepub.com/home/cnu Over the past few decades advances in the prevention, diagnosis and treatment of cardiovascular diseases (CVDs) have resulted in marked reductions in age- and sex- adjusted mortality. 1 Regardless, CVD continues to exact a disproportionate toll on several ethnic and racial groups, and for many these disparities have grown in magnitude over time with generally smaller improvements seen in minority groups. 2,3 Numerous complex factors have con- tributed to what is often referred to as the ‘treatment gap’ between ethnic and non-ethnic populations, 4–6 the majority of which can be categorized into three levels: patient, health-care system and environmental. 4,7 At the patient level there are distinct and well- established differences in CVD risk factor profiles that place ethnic groups at higher risk. For example, for dec- ades blood pressure has been significantly higher for African-Americans with an earlier onset of hypertension compared with their White counterparts, 8 South Asians tend to have a disproportionate burden of diabetes and more harmful types of low-density lipoprotein cholesterol and less helpful types of high-density lipoprotein choles- terol compared with those with European ancestry, 2 and a disproportionate prevalence of diabetes, up to six time higher, in Hispanics, non-Hispanic Blacks and non-His- panic Asians compared with non-Hispanic Whites. 2 Further compounding the issue is the significant atypical presentation of cardiac symptoms in ethnic groups such as African-American, Asian, South Asian and Hispanic. 9 Also at the patient level, cultural norms, values and prac- tices contribute to increased risk of CVD. For example, individual health behaviours such as exercise and diet (e.g. high concentration of oil and ghee used in Indian diets), 10 illness beliefs that result in poor symptom recog- nition, 11 poor health literacy which contributes to medica- tion non-adherence, 12 and social and family structure that impacts on timeliness to seek and act on professional advice. 11 At the health system level cultural competency plays a key role. For example, unintentional bias stemming from inadequate knowledge and sensitivity to cultural differ- ences of patients from ethnic backgrounds can lead to differential treatment and referral patterns. 4 Not only do ethnic groups experience limited access to care in gen- eral, 13 they face more barriers to CVD diagnosis, 14,15 lower rates of cardiac intervention 4 and overall lower quality health care. 16 Additionally, ethnic groups have a higher prevalence of unrecognized CVD risk factors that remain untreated, resulting in higher morbidity and mortality. 7 To ensure delivery of culturally appropriate cardiovascular care, providers should be aware of their own cultural val- ues and beliefs, and develop a cultural repertoire that ena- bles them to engage effectively with diversity and promote culturally sensitive care. 17 Other notable variables at the health systems level include higher-quality facilities being less accessible to ethnic groups, complexities involved in navigating bureaucracy and administration, for example, access to insurance and pharmaceutical benefits, and fail- ure to address language and health literacy barriers. 18 In addition, more attention needs to be focused not only on the experiences and needs of patients, but of their family members, especially the partner, who often influences and provides much informal care, especially in acute presenta- tion and during early convalescence. 19 Factors at the environmental level predominantly encompass those relating to socioeconomic status. Environmental factors consist of educational attainment, subjective perceptions of social status and social class, lin- guistic isolation, geographical location and fiscal variables such as insurance status. 20 Socioeconomic differences in health outcomes have been widely documented for most health conditions and ethnic groups. People who are poorer and less educated are more likely to suffer from diseases, to experience loss of functioning, to be cognitively and Why is ethnicity important in cardiovascular care? Chantal F Ski 1,2 , David R Thompson 1,2 , Donna Fitzsimons 2 and Kathryn King-Shier 3 1 Department of Psychiatry, University of Melbourne, Australia 2 School of Nursing and Midwifery, Queen’s University Belfast, UK 3 Faculty of Nursing, University of Calgary, Canada Corresponding author: Chantal F Ski, Department of Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC 3010, Australia. Email: chantal.ski@unimelb.edu.au 741892CNU 0 0 10.1177/1474515117741892European Journal of Cardiovascular NursingSki et al. editorial 2017 Editorial