Differences in medical care and disease outcomes among black and white women with heart disease.
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.


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.
Jha
Ashish K
AK
Division of General Medicine, San Francisco VA Medical Center, San Francisco, USA. ajha@hsph.harvard.edu
Varosy
Paul D
PD
Kanaya
Alka M
AM
Hunninghake
Donald B
DB
Hlatky
Mark A
MA
Waters
David D
DD
Furberg
Curt D
CD
Shlipak
Michael G
MG
D001741:Black or African American; D000368:Aged; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000628:therapy; D003327:Coronary Disease / Q000453:epidemiology / Q000208:ethnology* / Q000517:prevention & control; D003695:Delivery of Health Care; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017063:Outcome Assessment, Health Care; D016016:Proportional Hazards Models; D044469:Racial Groups; D012307:Risk Factors; D044465:White People