Racial Disparities in Adverse Cardiovascular Outcomes After a Myocardial Infarction in Young or Middle-Aged Patients.
Racial Disparities in Adverse Cardiovascular Outcomes After a Myocardial Infarction in Young or Middle-Aged Patients.
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DOI：
10.1161/jaha.121.020828
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发表时间：
2021-09-07
影响因子：
5.4
通讯作者：
Vaccarino V
中科院分区：
文献类型：
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作者：
Garcia M;Almuwaqqat Z;Moazzami K;Young A;Lima BB;Sullivan S;Kaseer B;Lewis TT;Hammadah M;Levantsevych O;Elon L;Bremner JD;Raggi P;Shah AJ;Quyyumi AA;Vaccarino V
黑人患者患冠状动脉疾病的年龄往往比其他群体年轻。以前关于心肌梗死（MI）结局的种族差异的数据不一致，且仅限于老年人群。我们的目的是研究青年和中年患者MI结局的种族差异以及社会经济、心理社会和临床差异所起的作用。我们研究了313名参与者（65%为非西班牙裔黑人），年龄<61岁，在埃默里附属医院因确诊的1型MI住院，并随访了5年。我们使用考克斯比例风险模型来估计种族与复发性MI、卒中、心力衰竭或心血管死亡复合终点的相关性，并对人口统计学、社会经济状况、心理和临床风险因素进行调整。平均年龄为50岁，50%为女性。与非黑人患者相比，黑人患者的社会经济地位较低，临床和心理社会风险因素较多，但血管造影冠状动脉疾病较少。黑人患者（35%）的5年心血管事件发生率高于非黑人患者（19%）：风险比（HR）2.1，95% CI，1.3 - 3.6。调整社会经济地位削弱关联（HR 1.3，95% CI，0.8-2.4）比调整临床和心理危险因素。较低的收入解释了46%的种族相关结果差异。在心肌梗死的年轻和中年成年幸存者中，黑人患者的不良结局风险高出2倍，这主要是由上游社会经济因素而不是下游心理和临床风险因素驱动的。
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. 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. 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.