INVESTIGATING RACIAL DISPARITIES IN OUTCOMES AFTER AMI

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Black Americans are believed to bear a disproportionate share of death and disability from cardiovascular disease. A principal goal of the Healthy People 2010 agenda is to eliminate such disparities. To date, however, studies of racial differences in acute myocardial infarction (AMI) outcomes have been limited to an examination of mortality without systematic evaluation of health status outcomes (symptoms, function and quality of life). In addition, the contribution of modifying factors such as co-morbidities (e.g. diabetes), differences in metabolism, or potential genetic determinants to racial difference in AMI outcomes have not been explored. Our preliminary data suggest that the health status outcomes (the symptoms, function and quality of life) of black patients are significantly worse than whites 6 months after AMI. Building upon this insight, we plan to enroll 4,500 patients over 3 years from 15 centers to test the fundamental hypothesis that black AMI patients have worse health status outcomes 1 year after an AMI than white patients. We also plan to evaluate the interaction of diabetes with racial background on outcomes in this cohort. Each consenting patient will undergo a baseline interview, abstraction of their medical record, donation of a fasting blood specimen for lipid and genetic analyses and detailed follow-up interviews at 6- and 12-months after their AMI. The specific aims of this SCCOR project include: 1) to describe racial differences in 1-year health status outcomes; 2) to describe racial differences in AMI care and test whether these differences account for observed disparities in 1-year health status outcomes; 3) to describe racial differences in the serum triglyceride lipidome among diabetic and non-diabetic AMI patients and test whether these differences account for disparities in 1-year outcomes; and 4) to determine whether racial differences in genetic variants of the PPAR regulatory complex among diabetic and non-diabetic AMI patients account for observed racial differences in 1-year outcomes. Through the rigorous description of racial differences in outcome, and the examination of multiple potential socio-economic, treatment, metabolic and genetic mediators, we will identify opportunities to eliminate racial disparities in outcomes after AMI.