Gender, Ethnic Gaps Found in Heart Care

Men, blacks usually fare worse, studies find

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HealthDay Reporter

WEDNESDAY, Nov. 10, 2004 (HealthDayNews) -- Disparities exist between the sexes and ethnic groups both in controlling risk factors for heart disease and in outcomes of major problems such as heart attacks.

One of several studies presented Tuesday at the American Heart Association's scientific sessions in New Orleans found both gender and ethnic inequalities exist in the treatment and control of high cholesterol.

At least 22.3 percent of all participants had cholesterol levels for which guidelines recommend medication.

Men were treated less often than women for LDL (the "bad" cholesterol) levels, and were less likely to keep those levels under control.

"Women were more likely to be controlled and more likely to be treated," study author David Goff said. "Men have an increased prevalence of dyslipidemia [higher or lower cholesterol levels] compared with women. Men were less likely to be treated and, among all patients, less likely to be controlled."

Similarly, blacks and Hispanic-Americans were less likely to have their cholesterol levels treated and controlled than whites, said Goff, a professor of public health science and internal medicine at Wake Forest University School of Medicine.

Overall, only 39 percent of people meeting the criterion for drug therapy actually received treatment.

Slightly more than half (55.9 percent) of those appropriately treated for high cholesterol actually had their cholesterol under control.

"This gives us a sense of the scope of the challenge that we face in our country," Goff said. "Quality improvement efforts are needed to improve overall quality of care and eliminate gender and ethnic disparities."

A second study in this vein found that, over the course of two years, blacks had inferior cholesterol control despite similar statin use to other groups. "At two years, fewer African-Americans had achieved the recommended target of LDL less than 100," said Dr. Sanjaya Khanal of Henry Ford Hospital in Detroit. This may have contributed to the increased rate of mortality and adverse events that was seen, he added.

Another study also presented Tuesday found that blacks who have heart attacks are 1.7 times likelier to die than whites one year after being in the hospital.

While 30-day mortality rates were similar (6.7 percent of blacks died and 6.6 percent of whites), within one year of treatment, an additional 5 percent of blacks had died, vs. only 2.9 percent of whites.

Blacks were also more likely to suffer a major bleeding event or stroke within the first 30 days after treatment, said the researchers, who were from the Duke Clinical Research Institute in Durham, N.C.

Moreover, black patients were generally younger than their white counterparts.

A third trial showed that Crestor (rosuvastatin) was better at reducing LDL in blacks than was a competitor, Lipitor (atorvastatin).

"This was the largest prospective trial comparing lipid-modifying treatments in African-American patients ever," said study co-author Dr. Keith Ferdinand, medical director of Heartbeats Life Center in New Orleans.

Crestor at 10- and 20-milligram doses reduced cholesterol by 37 percent and 46 percent respectively, compared to 32 percent and 39 percent for the same doses of Lipitor.

"This adds to physicians' comfort level," Ferdinand said. "It's an additional study to show that Crestor is more effective and safe."

More information

Visit the Association of Black Cardiologists for more on blacks and heart disease.

SOURCES: David C. Goff, M.D., Ph.D., professor, public health science and internal medicine, Wake Forest University School of Medicine, Winston-Salem, N.C.; Keith Ferdinand, M.D., medical director, Heartbeats Life Center, New Orleans; Sanjaya Khanal, M.D., director, Interventional Cardiovascular Fellowship Cardiac Catheterization Laboratory, Henry Ford Hospital, Detroit; Nov. 9, 2004, presentations, American Heart Association scientific sessions, New Orleans

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