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Cardiovascular Disease Events and Mortality After Myocardial Infarction Among Black and White Adults: REGARDS Study
J Walker Blackston1, Monika M Safford2, Matthew T Mefford1
1Department of Epidemiology (J.W.B., M.T.M., V.J.H., E.B.L.), University of Alabama at Birmingham School of Public Health.
Insights
Black individuals face higher risks of cardiovascular events and death after myocardial infarction (MI) compared to White individuals. These disparities are linked to pre-MI health status and MI characteristics, highlighting the need for improved prevention and treatment.
Area of Science:
- Cardiology
- Public Health
- Health Disparities
Background:
- Racial disparities in outcomes after myocardial infarction (MI) persist despite overall improvements in prognosis.
- Understanding these disparities is crucial for developing targeted interventions.
Purpose of the Study:
- To examine racial disparities between Black and White adults in cardiovascular disease (CVD), coronary heart disease, stroke, heart failure (HF), and mortality after MI.
- To identify characteristics that may explain these observed disparities.
Main Methods:
- A prospective cohort study of 1122 participants with incident MI from the REGARDS study (2003-2016).
- Follow-up for subsequent CVD events, coronary heart disease events, stroke, HF events, and all-cause mortality.
- Statistical analysis using hazard ratios, adjusting for sociodemographic factors, pre-MI health status, and MI characteristics.
Main Results:
- Black participants (37.5%) had a higher unadjusted hazard ratio for CVD events post-MI compared to White participants (1.42).
- Adjusting for pre-MI health status and MI characteristics substantially attenuated these disparities.
- Similar patterns were observed for other outcomes, though stroke event numbers were limited.
Conclusions:
- Black individuals exhibit a higher risk of CVD events and mortality following MI compared to White individuals.
- Pre-MI health status and MI characteristics are key factors explaining these racial disparities.
- Primordial prevention of risk factors and enhanced acute treatment strategies are essential to reduce post-MI outcome disparities.
Background:
Despite improvements in prognosis following myocardial infarction (MI), racial disparities persist. The objective of this study was to examine disparities between Black and White adults in cardiovascular disease (CVD), coronary heart disease, stroke, heart failure (HF), and mortality after MI and characteristics that may explain the disparities.
Methods:
This prospective cohort study included 1122 REGARDS (Reasons for Geographic and Racial Differences in Stroke) study participants with incident MI between 2003 and 2016. We followed participants for subsequent CVD events (MI, stroke, HF hospitalization, or death from CVD; n=431), coronary heart disease events (MI or death from coronary heart disease; (n=277), stroke (n=68), HF events (HF hospitalization or death from HF; n=191), and all-cause mortality (n=527; 3-year median follow-up after MI).
Results:
Among 1122 participants with incident MI, 37.5% were Black participants, 45.4% were women, and mean age was 73.2 (SD, 9.5) years. The unadjusted hazard ratio for CVD events comparing Black to White participants was 1.42 (95% CI, 1.17-1.71). Adjusting for sociodemographic characteristics did not attenuate the association (1.41 [95% CI, 1.14-1.73]), but further adjusting for pre-MI health status (1.25 [95% CI, 1.00-1.56]) and characteristics of the MI (1.01 [95% CI, 0.80-1.27]) resulted in substantial attenuation. Similar patterns were observed for the other outcomes, although the number of strokes was small.
Conclusions:
Black individuals had a higher risk of CVD events and mortality after MI than White individuals. The disparities were explained by health status before MI and characteristics of the MI. These findings suggest that both primordial prevention of risk factors and improved acute treatment strategies are needed to reduce disparities in post-MI outcomes.
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