Does guideline-based treatment prevent racial disparities in cardiovascular outcomes?

Nov. 10, 2023
New study.

Cardiovascular disease remains the leading cause of death for women within most racial and ethnic groups in the United States. A new study in the Canadian Journal of Cardiology, published by Elsevier, characterizes the risk profile for black and nonblack women with obstructive coronary artery disease (CAD) enrolled in the Women’s Ischemia Syndrome Evaluation (WISE) cohort study.

It concludes that racial and ethnic disparities in long-term cardiovascular outcomes were not observed among women with obstructive CAD recruited from university/academic centers who received guideline-based treatment.

Prior studies had demonstrated striking disparities in heart disease outcomes in black versus nonblack women with nearly 20% higher rates of cardiovascular mortality in black women. However, reasons for these disparities have been unclear. The authors of the present study set out to characterize the risk profile for black and nonblack women with obstructive CAD and explore the factors associated with long-term adverse outcomes in this population using data from the WISE study.

The original WISE cohort recruited 944 eligible women with symptoms and/or signs of myocardial ischemia undergoing clinically indicated coronary angiography from September 1996 to March 2000 in university/academic centers. Of the 944 women (mean age 58±12; 17% non-Hispanic black), 364 (38%) were diagnosed with CAD. The nonblack group included predominantly white women, with a minority comprised of Asian, Hispanic, Native American women.

In this current secondary analysis of the WISE cohort, investigators found that compared to nonblack women, black women had a relatively higher burden of cardiovascular risk factors (obesity and hypertension) and overall lower socioeconomic position (lower levels of education and income and higher proportion of public health insurance). Yet long-term cardiovascular outcomes, including death from heart disease, in women with obstructive CAD were similar between black and nonblack women.

Because the cohort of women was enrolled in university/academic centers and black women had similar or higher use of guideline-directed therapy for CAD including statin cholesterol-lowering medication, ACE inhibitors, and angiotensin 2 receptor blockers, the researchers postulate that black women with CAD treated in university/academic centers may experience less racial and ethnic discrimination and receive appropriate guideline-directed therapy.

Elsevier release on Newswise