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How to study the prevalence and mechanisms of racial differences in coronary vasomotor response
1Department of Cardiovascular Medicine, Kyoto University, Graduate School of Medicine, Hamamatsu Rosai Hospital, Japan. sasayama@wonder.ocn.ne.jp
Insights
Cardiovascular disease treatment guidelines may not apply to all races due to differing disease patterns. Research highlights unique pathophysiological differences, such as higher vasospastic angina in Japanese populations, necessitating race-specific clinical guidelines.
Area of Science:
- Cardiology
- Genetics
- Public Health
Background:
- Clinical practice guidelines for cardiovascular diseases are based on large trials, but individual responses vary.
- Recommendations derived from one population may not be universally applicable across different racial groups.
- Significant epidemiological and pathophysiological disparities exist in cardiovascular diseases among racial groups.
Purpose of the Study:
- To assess epidemiological and pathophysiological differences in cardiovascular diseases across racial groups.
- To investigate the applicability of current guidelines to diverse populations.
- To advocate for the development of race-specific therapeutic guidelines.
Main Methods:
- Comparative analysis of cardiovascular disease incidence and characteristics across different racial groups.
- Review of existing clinical trial data and previous comparative studies.
- Examination of etiological factors, including coronary artery disease, heart failure, and vasospastic angina.
Main Results:
- Coronary artery disease incidence is lowest in Japan among industrialized nations.
- Japanese patients with acute myocardial infarction show fewer cardiac events than Caucasians, even with similar infarct sizes.
- Non-ischemic cardiomyopathy is more prevalent in Japan, while vasospastic angina is significantly higher in Japanese populations compared to Italians.
Conclusions:
- Coronary spasm plays a crucial role in myocardial infarction pathogenesis in Japan, influencing treatment choices like calcium antagonist use.
- Inotropic agents, contraindicated in chronic heart failure for some populations, may be beneficial for Japanese patients, improving quality of life.
- Developing race-specific evidence and guidelines is essential for optimal cardiovascular disease management across diverse populations.
Abstract:
The rapid progress of therapeutic modalities of cardiovascular diseases have led to the development of clinical practice guidelines on the basis of large scale clinical trials. However, an individual response of each patient may not match the mean effect of an intervention in these trials. Therefore, recommendations based on clinical trials performed in a given patient population may not be applicable to the other races. Here, we assessed epidemiological and pathophysiological differences in cardiovascular diseases across racial groups. The incidence of coronary artery disease is the lowest in Japan of all the industrialized nations. Our previous study that compared post-hospital course of acute myocardial infarction in Japanese and Caucasians in North America demonstrated that cardiac events were significantly less in Japanese even when the initial infarct size was similar. Ischemic heart disease constitutes the most common cause of heart failure in the United States but nonischemic cardiomyopathy occurs more frequently in Japan. On the other hand, vasospastic angina is by far more common in the Japanese population. The first comparative study we carried out in Japanese and Italian patients with acute myocardial infarction also showed that percentage of vasospasm in the infarct-related arteries is 3 times higher in Japanese. Thus, coronary spasm appears to be more important as well as the pathogenesis of myocardial infarction in Japan. This fact was reflected by the more frequent use of calcium antagonists in Japan during the acute phase of myocardial infarction. On the other hand, the use of inotropic agents has now been contraindicated for the treatment of patients with chronic heart failure, however it may not be the case in the Japanese population in whom mortality is relatively low. Cardiotonic therapy could be justified in Japanese as it allows optimal care in the context of relief of symptoms and an improved quality of life. Therefore, each racial group should obtain specific evidence aimed at developing its own guidelines for therapy rather than translating major guidelines developed for other populations.