Coronary artery disease in blacks of lower socioeconomic status: Angiographic findings from the Cook County Hospital Heart Disease Registry

Simmons, Brian E.; Castañer, Angel; Campo, Adalberto; Ferlinz, Jack; Mar, Maxine; Cooper, Richard S.

doi:10.1016/0002-8703(88)90254-2

Cited by 32 publications

(8 citation statements)

References 19 publications

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“…One possible explanation is that very overweight persons with extensive CAD are underrepresented in this patient series. Consistent with this, in data reported by Simmons et al (12), mean body mass index was significantly higher in black women without versus with CAD. Relevant selection factors may include a greater likelihood of death or of disease manifestations either contraindicating or obviating a need for angiography.…”

Section: Shiriki Kumanyikasupporting

confidence: 84%

“…Associations that are less dramatic or that are partly subsumed by other risk factors would be the most likely to be distorted or to be absent under these circumstances. This may partly explain why associations of CAD with obesity and in some cases hypertension tend to be absent in angiography studies, in both black and white patients (3,4,6,9,12).…”

Section: Shiriki Kumanyikamentioning

confidence: 99%

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Searching for the Association of Obesity with Coronary Artery Disease

Kumanyika

1995

Obesity Research

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In this issue of OBESITY RESEARCH AdamsCampbell et al.(1) present an interesting analysis relating to the possible link between obesity and heart disease among African-American men and women. They advance the finding that obesity is either unrelated to coronary artery disease (CAD) or is related in an inverse U-shaped manner; that is, higher CAD prevalence in those moderately overweight compared to those either less or more overweight. This finding is based on direct assessment of the extent of coronary artery stenosis by arteriographic studies (angiography). Sixty percent and 40%, respectively, of the men and women in the population studied by these authors had clinically significant CAD. Those with CAD were two or three times more likely to have a history of diabetes and approximately twice as likely to have lipid abnormalities. In contrast, the proportions with body mass index classified as moderately or severely overweight using the National Center for Health Statistics definitions (7) did not differ significantly by CAD status in univariate analysis. Multivariate analyses suggested the non-linear association described above.Adams-Campbell et al.(1) emphasize that attempts to clarify the association of obesity with health outcomes such as CAD in the African-American population are of substantial public health importance because of the high proportion of African-American men and women who are overweight (7). In the 1988-91 National Health and Nutrition Examination Survey (NHANES 111), 31.2% and 49.1%, respectively, of nonHispanic black males and females were overweight among 20-to 74-year-olds overall: the proportion was higher in some age groups, particularly among women. The age-adjusted prevalence of overweight in AfricanAmerican (non-Hispanic black) women is 1.5 times that of non-Hispanic white women in the NHANES I11 data (7).Mortality and morbidity rates for obesity-related conditions such as hypertension, diabetes, and heart disease are also disproportionately high among AfricanAmericans (7.8). In 1991, the black to white ratio of total heart disease mortality (i.e., including both hypertensive heart disease and coronary heart disease [CHD]), was 1.39 for men and 1.64 for women. The CHD differential is currently of particular concern because it reflects an unfavorable time trend. CHD mmtality was 25% lower among black compared to white men in the 1960s but is now three percent higher in black men (8). In women CHD mortality was similar for blacks and whites in the 1960s but is now 33% higher in black women. CHD mortality has declined for both blacks and whites, but the rate of decline is less in blacks.The Adams-Campbell et al. findings are a timely reminder of the general difficulty of pinpointing how much and under what circumstances obesity contributes to CHD, especially among African-Americans. The association is not clear cut in white populations but has been documented in several major studies (10). In contrast, as reviewed elsewhere ( 5 ) , the two classical studies of heart disease in U.S. blac...

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Section: Shiriki Kumanyikasupporting

confidence: 84%

Section: Shiriki Kumanyikamentioning

confidence: 99%

Searching for the Association of Obesity with Coronary Artery Disease

Kumanyika

1995

Obesity Research

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“…It is not often emphasised that CASS, a landmark multicentre study, enrolled only 573 African-American patients over 5 years, a mere 2.3% of the nearly 25 000 study patients. The higher prevalence of normal arteriograms in African-Americans presenting with chest pain has been noted in other studies since CASS; however, the prevalence of left main coronary disease and three-vessel disease in these studies is greater than that reported in CASS 58 . In addition, other data show greater coronary atherosclerosis in young African-American males 59 and a poorer prognosis after myocardial infarction, especially in women compared to whites.…”

Section: Ischaemic Heart Diseasecontrasting

confidence: 49%

Using Angiotensin Converting Enzyme Inhibitors in African-American Hypertensives: A New Approach to Treating Hypertension and Preventing Target-Organ Damage

Flack

Mensah

Ferrario

2000

Current Medical Research and Opinion

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Angiotensin converting enzyme (ACE) inhibitors have been avoided as an initial therapeutic option in the treatment of hypertension in African-Americans. A major reason for this has been the widespread perception of clinicians that these agents have poor blood pressure (BP) lowering efficacy in this population. Remarkably uniform and pervasive interpretations of clinical trial data have formed the basis of this clinical perception and can be summarised as follows: (1) there has been a lesser BP lowering effect of ACE inhibitors in African-Americans compared to whites, particularly at low doses; and (2) short-acting ACE inhibitors like captopril prescribed at the midpoint of its maximal total daily dose lower BP less effectively than higher doses of calcium antagonists in African-Americans. A reinterpretation of published data from these same clinical trials suggests that: (1) the majority of African-Americans have meaningful BP responses to ACE inhibitors, albeit at a higher average dose than in whites; and (2) high levels of dietary sodium intake appear to explain a significant portion of the racial differences in BP response at the lower doses of ACE inhibitors. Thus, ACE inhibitors can effectively lower BP in African-Americans. These data suggest that the clinician should not avoid these agents in African-Americans because of a presumed lack of BP lowering efficacy. Rather, we should recognise the importance of adequate drug dosing and modest reductions in dietary sodium intake in augmenting the BP lowering effect of ACE inhibitors in hypertensive African-Americans.

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“…In this group, 19% of black men had no significant stenoses, compared to 7% of white men. In contrast to previous studies showing less‐severe obstructive coronary disease among blacks compared to whites, 15–17,21 we studied a cohort of men who had similar clinical syndromes. In addition, we were able to gather detailed data regarding features of the clinical presentation that are likely to predict significant stenoses.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the high rates of coronary artery disease mortality in the black population, coronary angiographic studies since the 1970s have repeatedly suggested lower rates of obstructive coronary artery disease among blacks than among otherwise similar whites 15–17 . However, in these studies, the indications for coronary angiography frequently differed between the whites and blacks.…”

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Black-white differences in severity of coronary artery disease among individuals with acute coronary syndromes

et al. 2002

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OBJECTIVE:To determine whether the extent of coronary obstructive disease is similar among black and white patients with acute coronary syndromes. DESIGN:Retrospective chart review. PATIENTS:We used administrative discharge data to identify white and black male patients, 30 years of age or older, who were discharged between October 1, 1989 and September 30, 1995 from 1 of 6 Department of Veterans Affairs (VA) hospitals with a primary diagnosis of acute myocardial infarction (AMI) or unstable angina (UnA) and who underwent coronary angiography during the admission. We excluded patients if they did not meet standard clinical criteria for AMI or UnA or if they had had prior percutaneous transluminal coronary angioplasty or coronary artery bypass grafting. MEASUREMENTS AND MAIN RESULTS:Physician reviewers classified the degree of coronary obstruction from blinded coronary angiography reports. Obstruction was considered significant if there was at least 50% obstruction of the left main coronary artery, or if there was 70% obstruction in 1 of the 3 major epicardial vessels or their main branches. Of the 628 eligible patients, 300 (48%) had AMI. Among patients with AMI, blacks were more likely than whites to have no significant coronary obstructions (28/145, or 19%, vs 10/155 or 7%, P = .001). Similarly, among patients with UnA, 33% (56/168) of blacks but just 17% (27/160) of whites had no significant stenoses (P = .012). There were no racial differences in severity of coronary disease among veterans with at least 1 significant obstruction. Racial differences in coronary obstructions remained after correcting for coronary disease risk factors and characteristics of the AMI. CONCLUSIONS:Black veterans who present with acute coronary insufficiency are less likely than whites to have significant coronary obstruction. Current understanding of coronary disease does not provide an explanation for these differences.KEY WORDS: coronary atherosclerosis; race; acute myocardial infarction; unstable angina; acute coronary syndromes. J GEN INTERN MED 2002;17:876±882. A frican Americans (blacks) do not appear to have shared equally in recent declines in age-adjusted mortality rates due to coronary artery disease (CAD). Whereas there is some evidence that black males had lower coronary artery disease mortality than white men during the 1950s and 1960s, 1±3 more recent data suggest that mortality rates among blacks now exceed those for whites among old and young women, and among men under 65 years of age. 3±5 The reasons for these different trends in mortality rates are unclear. Certain coronary risk factors, including diabetes, obesity, and tobacco use are more prevalent among blacks than whites. 6±9 Alternatively, less extensive use of advanced treatment for coronary artery disease in the black population may contribute to poorer outcomes. This has been most convincingly demonstrated for revascularization procedures. 10±14Despite the high rates of coronary artery disease mortality in the black population, coronary angiographic s...

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Coronary artery disease in blacks of lower socioeconomic status: Angiographic findings from the Cook County Hospital Heart Disease Registry

Cited by 32 publications

References 19 publications

Searching for the Association of Obesity with Coronary Artery Disease

Searching for the Association of Obesity with Coronary Artery Disease

Using Angiotensin Converting Enzyme Inhibitors in African-American Hypertensives: A New Approach to Treating Hypertension and Preventing Target-Organ Damage

Black-white differences in severity of coronary artery disease among individuals with acute coronary syndromes

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