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(Circulation. 2003;108:1089.)
© 2003 American Heart Association, Inc.

Clinical Investigation and Reports

Differences in Medical Care and Disease Outcomes Among Black and White Women With Heart Disease

Ashish K. Jha, MD; Paul D. Varosy, MD; Alka M. Kanaya, MD; Donald B. Hunninghake, MD; Mark A. Hlatky, MD; David D. Waters, MD; Curt D. Furberg, MD, PhD; Michael G. Shlipak, MD, MPH

From the Division of General Medicine, San Francisco VA Medical Center (A.K.J., M.G.S.), Division of Cardiology (P.D.V., D.D.W.), and Department of Medicine (A.M.K.), University of California, San Francisco; Division of General Medicine, Brigham and Women’s Hospital (A.K.J.), Boston, Massachusetts; University of Minnesota School of Medicine (D.B.H.), Minneapolis, Minnesota; Stanford University School of Medicine (M.A.H.), Palo Alto, California; and Wake Forest School of Medicine (C.D.F.), Winston-Salem, North Carolina.

Correspondence to Dr Jha, Division of General Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston MA 02115. E-mail ajha{at}hsph.harvard.edu

Received December 31, 2002; de novo received April 18, 2003; revision received May 28, 2003; accepted June 6, 2003.

Background— The risk of cardiovascular mortality is higher among black women than white women, and the reasons for this disparity are largely unexplored. We sought to evaluate differences in medical care and clinical outcomes among black and white women with established coronary artery disease.

Methods and Results— Among the 2699 women enrolled in the Heart and Estrogen/progestin Replacement Study (HERS), we used Cox proportional hazards models to determine the association of race with risk of coronary heart disease (CHD) events independent of major cardiovascular risk factors or medical therapies. During an average of 4.1 years of follow-up, CHD events were twice as likely in black compared with white women (6.4 versus 3.1 per 100 person-years, hazard ratio, 2.1; 95% confidence interval, 1.5 to 2.8; P<0.001). Black women had higher rates of hypertension, diabetes, and hypercholesterolemia, yet were less likely to receive aspirin or statins. Black women less often had optimal blood pressure (56% versus 63%; P=0.01) and LDL cholesterol (30% versus 38%; P=0.04) control at baseline and during follow-up. After adjusting for these and other differences, black women still had >50% higher CHD event risk (hazard ratio, 1.52; 95% confidence interval, 1.1 to 2.1; P=0.03).

Conclusions— In a large cohort of women with heart disease, black women less often received appropriate preventive therapy and adequate risk factor control despite a greater CHD event risk. Interventions to improve appropriate therapy and risk factor control in all women, and especially black women, are needed.

Key Words: women • epidemiology • prevention

Related Article:

Explaining Racial Disparities in Coronary Outcomes in Women

William S. Weintraub and Viola Vaccarino
Circulation 2003 108: 1041-1043. [Extract] [Full Text]

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