A recent study conducted by researchers at the Yale School of Public Health shows that cardiac risk factors and prevention efforts differ significantly by characteristics such as age, sex and race, with black women falling under the category of most at-risk.
The study followed 2,369 patients who had suffered acute myocardial infarction, colloquially known as a heart attack, and monitored the patients for hypertension, hypercholesterolemia, diabetes, obesity and smoking habits. Researchers also observed the differences in secondary prevention efforts at and after hospital discharge, focusing on the prescription of certain medications such as antihypertensives, as well as counseling services designed to address issues like smoking or weight loss. The study, published in the Aug. 22 issue of the Journal of Women’s Health, found that a staggering 93 percent of patients exhibited at least one risk factor, with 40 percent showing signs of at least three.
Perhaps even more alarming is the fact that risk factors were significantly higher in African-American patients, regardless of age or sex. Black women in particular faced the most daunting set of risk factors, with 60 percent of black women aged 55 years or older demonstrating three or more risk factors.
“Often people think of all patients with heart attacks as being the same and lump groups together,” said Judith Lichtman, the study’s senior author and associate professor of epidemiology at SPH. This study, however, separated heart attack patient data by subgroups, suggesting that the health care system needs to attend to the underlying causes of these risk factor inconsistencies.
The link between certain subgroups and the level of attention they receive in secondary prevention strategies seems just as deeply interwoven with the characteristics of age, sex and race. The study found that white patients received more counseling in smoking cessation than their black counterparts. Similarly, black youth were found to be prescribed less medication than white youth, even though both groups faced the same risk factors.
Associate research scientist in epidemiology and study co-author Erica Leifheit-Limson expressed her surprise at the results.
“[We] wouldn’t think that one subgroup would differ from another,” she said, especially since the study was conducted consistently for all patients.
When asked about potential reasons for the discrepancies among subgroups, Lichtman was hesitant to pin down the cause on one variable. However, she did say the study’s findings highlight potential discrepancies in the treatment people receive after their heart attacks.
“From a clinical and public health perspective, we need to be more aggressive in ensuring equal secondary prevention for everyone,” Lichtman added.
Robert Harrington, chairman of the Department of Medicine at Stanford University, echoed these sentiments in a Saturday email.
These findings, he said, are “consistent” with observations from other research assessing health care disparities.
“Much work remains to be sure that we are offering equitable health care for all,” Harrington added.
Researchers said the next step is to focus on improving risk factor modification to decrease medical issues in post-heart attack patients.
The study was principally supported by CV Therapeutics, Inc., with funding for all analyses from CV Outcomes, Inc.