The prevention of heart failure in minority communities and discrepancies in health care delivery systems.
This article discusses risk factors for cardiovascular disease in the minority community, including hypertension, obesity, diabetes,and diet. The minority community exhibits important population differences regarding risk and outcomes for cardiovascular disease. The complete explanation for these differential outcomes is lacking and likely to be multifactorial in origin; however, disparities in health care (differences in the quality of health care that are not due to access-related factors or clinical needs, to preferences, or to the appropriateness of the intervention) may emanate from decisions made by the patient, provider, or health care system. Hypertension as a disease entity is strikingly pathologic in African Americans. Correspondingly, the incidence of cardiovascular mortality due to hypertensive heart disease is fourfold higher in African Americans than in non-Hispanic whites. Hypertension and heart failure can be treated effectively in the minority community with a regimen of agents not dissimilar from that used for the general population. Treatment regimens should be individualized based on the disease presentation, associated comorbidity, and disease severity and not on something as arbitrary as race.
Yancy
Clyde W
CW
The University of Texas Southwestern Medical Center, Dallas, TX 75390-9047, USA. clyde.yancy@utsouthwestern.edu
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D001741:Black or African American / Q000706:statistics & numerical data; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002423:Cause of Death; D002986:Clinical Trials as Topic / Q000592:standards; D017281:Cost of Illness; D003695:Delivery of Health Care / Q000592:standards*; D004232:Diuretics / Q000627:therapeutic use; D016021:Epidemiologic Studies; D006297:Health Services Accessibility / Q000592:standards*; D006333:Heart Failure / Q000208:ethnology* / Q000209:etiology / Q000517:prevention & control*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000208:ethnology; D015994:Incidence; D008913:Minority Groups / Q000706:statistics & numerical data; D009765:Obesity / Q000150:complications / Q000208:ethnology; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011322:Primary Prevention / Q000379:methods / Q000592:standards; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014665:Vasodilator Agents / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D004232:Diuretics; D014665:Vasodilator Agents