Circulation. 2005;111:1203
(Circulation. 2005;111:1203.)
© 2005 American Heart Association, Inc.
Issue Highlights
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STATE OF DISPARITIES IN CARDIOVASCULAR HEALTH IN THE UNITED STATES, by Mensah et al.
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National health policy planners set an ambitious agenda in
Healthy People 2010 by committing to decreasing death and disability
in the United States by 25% by 2010. One of the fundamental
goals essential to achieving this objective is to eliminate
healthcare disparities. In this issue of
Circulation, Dr Mensah
and colleagues provide the Centers for Disease Control’s
most recent data on the prevalence of cardiovascular disease
and its risk factors by race and ethnicity. The investigators
report that racial/ethnic disparities in cardiovascular disease
and risk factors are ubiquitous regionally and nationally. Obesity
is common in all Americans but is particularly prevalent in
African American women (48.4%) and Mexican American men with
a high school education (29.7%). Hypertension prevalence was
high in African Americans (41.2%), whereas hypercholesterolemia
was high among whites. Hospitalizations for heart failure and
stroke were more common in the southeast and in African Americans.
Midway in the first decade of the 21st century, the reported
data underscore that the United States has tremendous persistent
racial/ethnic, socioeconomic, and regional disparities in cardiovascular
disease. If we are to continue to make major advances in reducing
death and disability from cardiovascular disease, we must overcome
the extensively documented racial/ethnic and socioeconomic health
disparities. See p
1233.
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RACIAL PROFILING: THE UNINTENDED CONSEQUENCES OF CORONARY ARTERY BYPASS GRAFT REPORT CARDS, by Werner et al.
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In the 1990s, several states implemented coronary artery bypass
graft (CABG) report cards with the well-intentioned goals of
improving CABG care and empowering informed consumer choices.
Anecdotally, some observers have voiced apprehensions that the
advent of report cards might have hidden costs. Physicians caring
for the highest-risk patients have been concerned that report
cards might incentivize surgeons to "cherry-pick" the healthiest
operative candidates and, conversely, deny care to the very
patients who by virtue of being at the highest risk also stand
to gain the most from CABG. Werner and colleagues examined the
influence of New York’s surgeon-specific CABG report cards
on racial and ethnic disparities in CABG surgery rates between
1988 and 1995. The investigators observed that, as compared
with states without report cards, the release of CABG report
cards in New York was associated with an initial increase in
racial/ethnic disparities in CABG use between white and African
American and Hispanic patients. The research underscores the
complexity of instituting quality improvement efforts. The investigators
note that the effectiveness of report cards as a method to improve
quality of care is uncertain and that their research suggests
CABG report cards might have unintended negative consequences.
See p
1257.
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ETHNIC DIFFERENCES IN CORONARY CALCIFICATION: THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS (MESA), by Bild et al.
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Computed tomographic coronary calcification is a measure of
subclinical disease that correlates with cardiovascular risk
factors and atherosclerotic plaque burden and that predicts
future coronary events. It has been noted that racial and ethnic
differences in coronary calcification exist, with US whites
having a higher prevalence than that of African Americans. The
higher prevalence of coronary calcification in US whites has
been puzzling given the higher levels of standard cardiovascular
disease risk factors in African Americans. Unfortunately, previous
studies of coronary calcification have been limited by being
largely referral based and having few racial/ethnic minorities.
Bild and colleagues report from the community-based Multi-Ethnic
Study of Atherosclerosis (MESA) that white men and women have
higher rates of coronary calcification than do their African
American, Hispanic, and Chinese counterparts. Furthermore, they
observe that these differences persist after accounting for
the disparities in cardiovascular disease risk factors between
the different races and ethnicities studied. The MESA Study
underscores that the pathogenesis of these ethnic differences
in coronary calcification must be sought. Whether there are
race/ethnicity prognostic differences in cardiovascular disease
outcomes associated with coronary calcification is unknown and
will be the focus of future MESA reports. Given that most thresholds
for defining abnormal coronary calcification have been developed
in whites, the present MESA study suggests that clinicians should
be cautious in assuming that the prognostic implications of
coronary calcification are the same across races and ethnicities.
See p
1313.
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