First myocardial infarction more likely to be fatal in black people

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Monika Safford (John J Kuiper Professor of Medicine and Chief of General Internal Medicine at Weill Cornell Medical College, New York, USA) and others report in Circulation that black people are twice as likely as white people to have fatal first cardiac event.

Safford et al examined cardiac events in three major heart studies and found that, in two of these studies, black adults aged 45–64 had about twice the risk of fatal events compared with white adults the same age. The same was true for older individuals, with less pronounced differences. The authors say that this high risk may be due to cardiovascular risk factors and the conditions in which people are born, grow, work and live—known as social determinants of health.

However, the findings differed for non-fatal events. Accounting for these same factors resulted in lower risk of non-fatal events in black men compared to white men, with similar patterns among women that were not statistically significant. According to Safford et al, blacks have a higher burden of unfavourable social determinants of health and cardiovascular risk factors, so the lower risk of non-fatal cardiac events among blacks, especially black men, after accounting for these factors was surprising. These findings suggest that some other factor that the researchers could not measure may be driving the findings.

Safford comments: “Our concern is that blacks may not be seeking medical attention for important symptoms that could signal heart problems. Greater public awareness of heart attack symptoms would benefit everyone. Many people think that heart attacks are only present if they have severe chest pain. In fact, many heart attacks cause only mild symptoms and people may mistakenly think they are having a bout of indigestion.”

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