Racial Disparities in Adverse Cardiovascular Outcomes After a Myocardial Infarction in Young or Middle-Aged Patients

• Type of Material: Article
• Authors: Mariana Garcia, Emory University; Zakaria Almuwaqqat, Emory University; Kasra Moazzami, Emory University; An Young, Emory University; Bruno B. Lima, Emory University; Samaah Sullivan, Emory University; Belal Kaseer, Emory University; Tene Lewis, Emory University; Muhammad Hammadah, Emory University; Oleksiy Levantsevych, Emory University; Lisa Elon, Emory University; J. Douglas Bremner, Emory University; Paolo Raggi, Emory University; Amit Shah, Emory University; Arshed Quyyumi, Emory University; Viola Vaccarino, Emory University
• Language: English
• Date: 2021-09-07
• Publisher: WILEY
• Publication Version: Final Published Version
• Copyright Statement: © 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1161/JAHA.121.020828
• Title of Journal or Parent Work: JOURNAL OF THE AMERICAN HEART ASSOCIATION
• Volume: 10
• Issue: 17
• Start Page: e020828
• End Page: e020828
• Grant/Funding Information: We would like to acknowledge the support of the Byron William Jr, MD Fellowship Fund. This work was supported by the National Institutes of Health (P01HL101398, R01HL109413, R01HL109413‐02S1, UL1TR000424, KL2TR000455, K24HL077506, K24 MH076955, K23HL127251, and THL130025A, TL1TR002382).
• Keywords: prognosis; Life Sciences & Biomedicine; socioeconomic position; cardiovascular disease; HEALTH; risk factors; ASSOCIATION; SEX; SOCIOECONOMIC-STATUS; Cardiovascular System & Cardiology; Science & Technology; MORTALITY; RACE; Cardiac & Cardiovascular Systems; RISK
• Research Categories: Health Sciences, Medicine and Surgery; Sociology, Public and Social Welfare

Abstract

BACKGROUND: Black patients tend to develop coronary artery disease at a younger age than other groups. Previous data on racial disparities in outcomes of myocardial infarction (MI) have been inconsistent and limited to older populations. Our objective was to investigate racial differences in the outcome of MI among young and middle-aged patients and the role played by socioeconomic, psychosocial, and clinical differences. METHODS AND RESULTS: We studied 313 participants (65% non-Hispanic Black) <61 years old hospitalized for confirmed type 1 MI at Emory-affiliated hospitals and followed them for 5 years. We used Cox proportional-hazard models to estimate the association of race with a composite end point of recurrent MI, stroke, heart failure, or cardiovascular death after adjusting for demographic, socioeceonomic status, psychological, and clinical risk factors. The mean age was 50 years, and 50% were women. Compared with non-Black patients, Black patients had lower socioeconomic status and more clinical and psychosocial risk factors but less angiographic coronary artery disease. The 5-year incidence of cardiovascular events was higher in Black (35%) compared to non-Black patients (19%): hazard ratio (HR) 2.1, 95% CI, 1.3 to 3.6. Adjustment for socioeconomic status weakened the association (HR 1.3, 95% CI, 0.8–2.4) more than adjustment for clinical and psychological risk factors. A lower income explained 46% of the race-related disparity in outcome. CONCLUSIONS: Among young and middle-aged adult survivors of an MI, Black patients have a 2-fold higher risk of adverse outcomes, which is largely driven by upstream socioeconomic factors rather than downstream psychological and clinical risk factors.