Black adults more likely to die of first MI vs. white adults
Among adults aged 45 to 64 years, black adults were at higher risk for fatal CHD, a difference explained by social determinants of health and CV risk factors, researchers reported.
However, black men were at lower risk for nonfatal CHD vs. white men.
“Our concern is that blacks may not be seeking medical attention for important symptoms that could signal heart problems,” Monika Safford, MD, John J. Kuiper Professor of Medicine and chief of general internal medicine at Weill Cornell Medical College, New York, said in a press release. “Greater public awareness of [MI] symptoms would benefit everyone. Many people think that [MIs] are only present if they have severe chest pain. In fact, many [MIs] cause only mild symptoms and people may mistakenly think they are having a bout of indigestion.”
Safford and colleagues compared incidence of fatal and nonfatal CHD and CHD case fatality between black and white adults without a history of CHD aged 45 to 64 years in the ARIC (6,479 men, 8,488 women) and REGARDS (5,296 men, 7,822 women) studies and aged 65 years or older in the CHS (1,836 men, 2,790 women) and REGARDS (3,381 men, 4,112 women) studies.
The rates of incident fatal and nonfatal CHD were assessed from baseline (1987-1989 for ARIC, 1989-1990 for CHS, 2003-2007 for REGARDS) to a maximum of 11 years of follow-up.
CHD risk in men
After adjustment for age, among those aged 45 to 64 years, black men had higher risk for fatal CHD than white men in the ARIC study (HR = 2.09; 95% CI, 1.42-3.06) and the REGARDS study (HR = 2.11; 95% CI, 1.32-3.38), but there was no difference between the groups in nonfatal CHD (HR in ARIC = 0.82; 95% CI, 0.64-1.05; HR in REGARDS = 0.94; 95% CI, 0.69-1.28).
After further adjustment for social determinants of health and CV risk factors, there was no longer a difference between black and white men in risk for fatal CHD (HR in ARIC = 1.19; 95% CI, 0.74-1.92; HR in REGARDS = 1.09; 95% CI, 0.62-1.93), but black men were at lower risk for nonfatal CHD (HR in ARIC = 0.64; 95% CI, 0.47-0.96; HR in REGARDS = 0.67; 95% CI, 0.48-0.95).
The researchers observed a similar pattern among men aged 65 years and older in the CHS and REGARDS studies.
CHD risk in women
Among women aged 45 to 64 years, after adjustment for age, black women had increased risk for fatal CHD vs. white women in the ARIC (HR = 2.61; 95% CI, 1.57-4.34) and REGARDS (HR = 1.79; 95% CI, 1.06-3.03) studies, and increased risk for nonfatal CHD in the ARIC study (HR = 1.47; 95% CI, 1.13-1.91), but there was no significant difference in risk for nonfatal CHD in the REGARDS study (HR = 1.29; 95% CI, 0.91-1.83).
After further adjustment for social determinants of health and CV risk factors, there were no significant differences between black and white women in risk for fatal CHD in ARIC (HR = 0.67; 95% CI, 0.36-1.24), fatal CHD in REGARDS (HR = 1; 95% CI, 0.54-1.85) and nonfatal CHD in REGARDS (HR = 0.7; 95% CI, 0.46-1.06), but black women had lower risk for nonfatal CHD than white women in ARIC (HR = 0.7; 95% CI, 0.51-0.97).
Among women aged 65 years and older, racial differences in incident CHD risk were attenuated, according to the researchers.
Case fatality, the rate of fatal CHD to total CHD, was higher in black adults than in white adults of both sexes even after multivariable adjustment, Safford and colleagues wrote.
“These findings highlight the importance of primary prevention among blacks because they are more likely to die after their incident CHD event compared with whites,” Safford and colleagues wrote. – by Erik Swain
Disclosures: Safford reports consulting for diaDexus and receiving grant support from Amgen. Another researcher reports receiving grant support from and serving on an advisory board for Amgen.