Although treatments have progressed for coronary heart disease within the last 20 years, African-American men and women continue to have twice the risk of fatal coronary heart disease in comparison to Caucasian men and women, suggests a new study in the November issue of the Journal of the American Medical Association.

This variance may be because of a larger amount of risk factors present among African-Americans, such as diabetes, hypertension, and smoking, implying that this risk could be terminated with better risk factor control.

Rates of coronary heart disease in the U.S. have consistently decreased since the 1970s for all races of people. The researchers of this study have discovered a steeper decline between 2000 and 2008 in acute coronary heart disease deaths for whites than blacks, increasing the long known variance between these racial groups.

The research team from the University of Alabama at Birmingham, examined death certificate information along with other data from four U.S. cities. Hospitalizations for heart attacks between 2002 and 2007 dropped significantly, and more so for caucasians than African-Americans, according to data from Kaiser Permanente.

The study’s lead author, Monika M. Safford, M.D., professor in the UAB Division of Preventive Medicine said:

“During the time period since the last reports on the incidence of heart disease, two things happened: statins came into wider use to manage coronary heart disease, and blood tests to detect heart attacks became more sensitive, enabling physicians to identify much smaller cardiac events. However, prior to our study, there were no data on how these two advances have impacted racial and sex differences in coronary heart disease rates.”

The investigators examined data from the NIH-funded Reasons for Geographic and Racial Differences in Stroke (REGARDS) study to view total coronary heart disease rates, nonfatal coronary heart disease rates and fatal rates among Caucasians and African-Americans, and among men and women.

They looked at whether risk factors for coronary heart disease were linked to the observed differences in risks by sex and race. The authors also viewed the effect of extremely small heart attacks on these differences. These items were part of their aim to measure if racial differences continue to be present and, if yes, to find out what the causes are.

Of the 24,443 participants in the UAB study, african americans and Caucasians had nearly the same average age, although reduced kidney function, smoking, diabetes, and inactivity were more common among blacks than whites. Body mass index and systolic blood pressure were also greater among African-Americans.

The participants were generally followed-up after an average of 4.2 years. In total, there were 659 heart attacks reported: 115 in white women, 138 in black women, 153 in black men, and 254 in white men.

Findings showed that despite the rate of prevalence of total coronary heart disease was close among white men and black men, the black men had a greater incidence of fatal coronary heart disease, and a lower occurrence of nonfatal coronary heart disease.

Generally, in comparison with earlier studies, the UAB investigators found that racial differences are still present in fatal coronary heart disease rates and the rate is connected with the weight of the risk factors.

Safford concludes:

“It’s very hard to prevent future heart disease when people die of their first sign of heart disease. This is frustrating because we have effective interventions available. To potentially reduce these persistent disparities, we need to improve our interventions targeted at this high-risk group, optimizing education and treatment for these well-established coronary heart disease risk factors among blacks.”

The authors believe that the surplus of risk factors in African-American men and women remain to be a huge public health danger, which could be leading to their high risk for death from coronary heart disease.

Written by Kelly Fitzgerald