NEW YORK (Reuters Health) - Even within the Veterans Affairs health system, where everyone should have the same access to care, African Americans are less likely than their white counterparts to be prescribed heart-protecting medications or undergo bypass surgery to treat blocked heart arteries, a new study finds.
The findings, based on data for nearly 475,000 VA patients, found that African Americans had lower rates of prescriptions for cholesterol-lowering statins, as well as ACE inhibitors and beta-blockers used to treat high blood pressure and certain heart problems. They were, however, more likely than white patients to be on aspirin.
At the same time, black patients were less likely than whites to have undergone coronary bypass surgery. The procedure is performed to reroute blood flow around heart-artery blockages, with the goal of relieving serious chest pain known as angina, and reducing the risk of heart attack.
Researchers say these racial gaps in drug prescriptions and bypass may help explain why heart disease deaths are not declining as rapidly among African Americans compared with other racial groups in the U.S.
“It’s likely this may be a result of the lesser use of these strategies,” lead researcher Dr. Jawahar L. Mehta, of the University of Arkansas for Medical Sciences in Little Rock, said in an interview.
The U.S. has seen an overall drop in heart disease deaths in recent decades, but African Americans remain at greater risk. In 2006, the heart disease death rate among white men was 245 per 100,000 men, while there were 321 deaths per 100,000 black men, according to figures from the Centers for Disease Control and Prevention.
Among women, there were 159 deaths per 100,000 white women, and 212 for every 100,000 black women.
Past studies have shown that African Americans receive fewer prescriptions for drugs that can lower the risk of heart disease or help treat it. One likely reason, researchers have speculated, is unequal access healthcare.
But the current study shows that racial disparities persist even in a large group of Americans with the same access to care. “It’s disconcerting that this is happening in the VA population,” Mehta said.
The findings, published in the American Journal of Cardiology, are based on VA records for 117,071 African-American and 357,494 white patients, mostly men.
Overall, 30 percent of white patients were on a statin, versus 20.5 percent of black patients. About 25 percent of whites were using beta-blockers, compared with 20 percent of African Americans, while 30 percent of whites and 28 percent of blacks were using ACE inhibitors.
This was despite the fact that about 44 percent of both black and white patients had high blood pressure. Similarly, nearly 7 percent of African Americans had angina, compared with almost 6 percent of their white counterparts. Just under 1 percent of patients in both racial groups had a history of heart attack.
When Mehta’s team accounted for a variety of factors -- including patients’ ages, incomes, smoking habits and diabetes diagnoses -- African-American race itself was still linked to a lower likelihood of various treatments.
African Americans were 46 percent less likely to be on a statin, one-quarter less likely to be on a beta-blocker and 6 percent less likely to be on an ACE inhibitor. The exception was aspirin, which African Americans were 31 percent more likely to be taking.
When it came to bypass surgery, 0.4 percent of black patients had had the procedure, versus 1.2 percent of white patients.
The reasons for the disparities are not clear. But Mehta speculated that socioeconomics is involved, even though patients had equal access to care. Lower-income patients may, for instance, be less aware of their heart disease risks and less assertive when it comes to talking with their doctors.
Mehta said it is important for African Americans to be aware of their relatively greater heart risks, and advised that they “not hesitate” to ask their doctors about their risk factors and how to manage them.
Lower prescription and bypass rates could also reflect a bias on the part of doctors, Mehta said. “But that is speculation,” he added. “We don’t have objective data to show that.”
SOURCE: American Journal of Cardiology, online February 16, 2010.
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