In research presented here today at the American College of Cardiology's 53rd Scientific Sessions, Emory researchers conclude the answers to these questions are troubling. Despite the fact that there has been increasing attention to sex and race related disparities in the management of myocardial infarction over the past decade, the scientists say there are gender and racial gaps in the U.S. between heart attacks therapies white men receive and those treatments offered to women and blacks.
The Emory Heart Center researchers studied the records of 672,817 white and black patients younger than 75 years of age from the National Registry of Myocardial Infarction. They examined differences from 1994 to 2002 by sex and race in the use of recommended treatments and procedures for MI (including reperfusion therapy, aspirin, beta blockers, and coronary angiography) among patients who were ideal candidates for each of these. They also examined differences in revascularization procedures among patients who had received coronary angiography.
"We found that African-American women and men have continued to receive less aggressive management than white men after myocardial infarction," says Emory investigator Viola Vaccarino MD, Ph.D., lead author of the study.
Gender and racial differences were greater for reperfusion therapy, coronary angiography and coronary artery bypass graph (CABG) surgery than for other MI treatments -- and black women were found to have the lowest use of these interventions. Treatment differences between white women and white men tended to be small, with the exception of CABG.
Dr. Vaccarino says the researchers were surprised to discover there has been no trend toward a lessening of the treatment gaps for women and blacks in recent years. "We don't know why these differences persist but they may be due to differences in socioeconomic status," she notes. "If this is the case, however, it is surprising that patients' socioeconomic status plays a role in clinical decision making in the setting of an acute illness such as MI."
In addition to Dr. Vaccarino, Jerome L. Abramson, Ph.D; Susmita Mallik, MD; and Nanette K. Wenger, MD, of the Emory University School of Medicine in Atlanta, Georgia, participated in this research. Ajay Manhapra, MD, of Hackley Hospital in Spring Lake, Michigan; Paul Frederick, Ph.D, of Ovation Research Group in Seattle, Washington; and Hal V. Barron, MD., of Genentech Inc. in San Francisco, California were also part of the research team.
The Emory Heart Center is comprised of all cardiac services and research at Emory University Hospital, Emory Crawford Long Hospital Carlyle Fraser Heart Center, the Andreas Gruentzig Cardiovascular Center of Emory University and the Emory Clinic. Ranked among the nation's top ten heart centers by U.S. News & World Report's annual survey, the Emory Heart Center has a rich history of excellence in all areas of cardiology and cardiac surgery --including education, research and patient care. It is internationally recognized as one of the birthplaces of modern interventional cardiology and was the site of the first coronary stent implantation in the United States, the only single site randomized comparison of angioplasty and bypass surgery and pioneering work in vascular brachytherapy.