Study on Cardiovascular Disease and Revascularization

Despite technical and pharmaceutical advancements and achievements in the last two decades and some decrease in overall mortality rate from cardiovascular disease (CVD), it remains the leading cause of death and economic burden. In a recent study, researchers have reported that racial and financial factors are linked with a lower likelihood of revascularization among patients presenting with acute myocardial infarction (AMI). The study findings were published in the American Heart Journal on January 06, 2022.

Historically race, income, and gender were associated with the likelihood of receipt of coronary revascularization for AMI. However, based on public health initiatives such as Healthy People 2010, it is unclear whether race and income remain associated with the likelihood of coronary revascularization among women with AMI.

But given the recent "increased awareness" of these issues and the drive to eliminate health disparities by various policies and programs, this study was designed to see if these efforts have made any difference, said lead author Tarryn Tertulien, MD in an interview.

For the present analysis, Dr. Tertulien and her team included data from the Women's Health Initiative on 5,284 postmenopausal women (9.5% Black, 2.8% Hispanic, 87.7% white; 23.2% with annual incomes < $20,000) presenting with acute MI over median 9.5 years follow-up (1993-2019). Proportional hazards models were adjusted for demographics, comorbidities, and AMI type. They stratified the results by revascularization type: percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). They then compared the trends by race and income between pre-and post-2010 using time-varying analysis.

Key findings of the study:

• Upon analysis, the researchers found that the Black race was associated with a lower likelihood of receiving revascularization for AMI compared to the White race in fully adjusted analyses [HR:0.79].
• Upon further stratification by type of revascularization, they found that the Black race was associated with a lower likelihood of PCI for AMI compared to the White race [HR:0.72] but not for CABG [HR:0.97].
• They noted that income was associated with a lower likelihood of revascularization [HR:0.90] for AMI.
• However, they observed no such differences in other racial/ethnic groups.
• They also noted that the time period (pre/post-2010) were not associated with a change in revascularization rates.

Dr. Khadijah Breathett said in an interview, "We all know women are less likely to receive appropriate care for cardiovascular treatment, and this shows that it's that much worse for Black women or for women with lower income."

The authors concluded, "Black race and income remain associated with lower likelihood of revascularization among patients presenting with AMI. There is a substantial need to disrupt the mechanisms contributing to race, sex, and income disparities in AMI management."

For further information:

DOI: https://doi.org/10.1016/j.ahj.2021.12.013