Black patients less likely to survive heart disease

NEW YORK (Reuters Health) - Adding to previous evidence, researchers have found that black patients with heart disease are less likely to survive than white patients, even those who are younger.

Race-related differences in surviving heart disease-which, according to the American Heart Association, affects 13 million Americans and is the leading cause of death in the U.S.-have been well documented in earlier studies.

But the new study, published in the American Heart Journal, showed that black patients were younger than the white patient group by about 2 years on average, yet still had a lower survival rate over a 15-year period. Black women had the lowest rate of survival, 41 percent, while white men had the highest at nearly 46 percent.

“It’s an odd paradox that you see black patients get the disease at a younger age,” lead author Dr. Kevin Thomas, of the Duke University Medical Center, told Reuters Health.

Thomas pointed out that the new study expands on prior research because the 15-year follow-up is longer than any other study on the subject. It also only focused on data from more than 22,000 people who had been diagnosed with severe heart disease.

Dr. Ali Sonel, who was not involved with the study, explained to Reuters Health that the difference in survival is partly due to key health differences between the black and white patients. Blacks were more likely to be obese and to have high blood pressure, diabetes, and circulation problems, all of which are risk factors for heart disease.

“You would almost expect the black patients to do worse based on their conditions at the beginning of the study,” said Sonel, a cardiologist at the University of Pittsburgh.

In their analysis, Thomas and his research team accounted for many of the differences between patient groups, including age, household income, pre-existing health conditions, and initial treatment, yet black patients still had a lower survival rate.

This, explained, Dr. Nakela Cook, a clinical medical officer at the National Heart, Lung, and Blood Institute, makes it difficult to determine the individual factors contributing to the disparity.

“I don’t think there’s one thing we can hang our hat on,” said Cook, who was not involved in the study. “There are multiple factors playing a role.”

Thomas explained that other potential factors not accounted for in the study include genetic differences and lifestyle choices, such as diet and exercise.

Taking control of things like diet and exercise, he suggested, is one way people can increase their chances of survival and could even help avoid the disease altogether.

“You can’t control your age or gender, but you can choose how much you eat, you can choose to exercise,” said Thomas.

He added that doctors can further improve care by creating guidelines based on the patient’s conditions, rather than on race, gender, or age.

“We need to hold physicians and hospitals accountable for getting patients the best possible care,” said Thomas. “If we do this, we can start eliminating the disparity in survival.”

SOURCE: American Heart Journal, October 2010.