Racial differences in long-term survival among patients with coronary artery disease

Area of Science:

• Cardiology
• Health Disparities
• Epidemiology

Background:

• Cardiovascular disease (CVD) is a leading cause of death in the US for both Black and White populations.
• Limited data exist on the long-term prognosis for Black patients with coronary artery disease (CAD).
• Understanding clinical determinants of outcome in Black patients with CAD is crucial.

Purpose of the Study:

• To compare the long-term survival of Black and White patients with significant coronary artery disease (CAD).
• To identify major clinical and demographic factors associated with survival differences.
• To investigate the role of initial treatment in survival disparities.

Main Methods:

• Analysis of 22,618 patients (3,314 Black) with significant CAD findings from cardiac catheterization (1986-2004).
• Kaplan-Meier and Cox modeling used for survival comparisons by race and gender.
• Follow-up data collected through June 2006 (median 7.6 years).

Main Results:

• Black patients with CAD were younger, more often female, had lower incomes, and higher rates of hypertension, diabetes, and heart failure.
• At 15-year follow-up, Black women had the lowest survival (41.5%) and White men the highest (45.8%).
• Blacks were less likely to receive initial coronary revascularization (OR 0.66). Black race remained an independent predictor of lower survival (HR 2.54) after adjustments.

Conclusions:

• Black patients with CAD exhibit lower long-term survival compared to White patients.
• Differences in cardiovascular risk factors and revascularization rates partially explain, but do not fully account for, the survival gap.
• Further research is needed to address the unexplained factors contributing to lower survival in Black individuals with CAD.