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Survival of black persons compared with white persons in the Coronary Artery Surgery Study (CASS)
Insights
Black individuals in the Coronary Artery Surgery Study (CASS) had higher rates of smoking and hypertension. Despite poorer survival, surgery improved outcomes for Black patients, suggesting further research is needed.
Area of Science:
- Cardiology
- Public Health
- Health Disparities
Background:
- Coronary Artery Surgery Study (CASS) enrolled 573 Black individuals between 1974-1979.
- Black participants exhibited higher prevalence of smoking and systemic hypertension compared to White participants.
- A notable percentage of Black individuals presented with normal coronary arteries on angiography, despite experiencing chest pain.
Purpose of the Study:
- To investigate survival rates and treatment outcomes for Black individuals within the CASS cohort.
- To explore the influence of risk factors like smoking and hypertension on cardiovascular health in Black populations.
- To evaluate the efficacy of surgical intervention for Black patients with coronary artery disease.
Main Methods:
- Retrospective analysis of data from the Coronary Artery Surgery Study (CASS).
- Comparison of demographic, clinical, and angiographic characteristics between Black and White participants.
- Survival analysis using age- and sex-adjusted rates and Cox proportional hazards models.
Main Results:
- The 5-year survival rate was lower for Black individuals (82%) compared to White individuals (88%).
- Black race was independently associated with poorer survival in the medically treated group (p=0.0006).
- Surgical therapy demonstrated a significantly better survival rate for Black patients (p=0.009).
Conclusions:
- Higher rates of smoking and hypertension may contribute to poorer survival in Black individuals.
- Coronary artery bypass surgery appears to improve survival outcomes for Black patients.
- Further research is warranted to understand the complex interplay of risk factors and treatment efficacy in Black populations.
Abstract:
From July 1974 to May 1979, 573 black persons in the Coronary Artery Surgery Study (CASS) underwent coronary angiography. Compared with 23,008 white persons, larger percentages of black men and women were current smokers and reported a history of systemic hypertension. Despite the presence of chest pain, larger percentages of blacks had normal coronary arteries by angiography than did whites. The 5-year age- and sex-adjusted survival rate was 88% for whites and 82% for blacks (p less than 0.0001). Cox analysis indicated that black race was related to poorer survival in the medical group (p = 0.0006) but not in the surgical group (p = 0.28). For blacks, surgical therapy was related to a better survival rate (p = 0.009). These results raise questions concerning the effects of excess cigarette smoking and systemic hypertension and the role of coronary artery bypass surgery on survival of black persons.