Improved and more consistent interventions could help to reduce the chances of a second heart attack, and possibly death, among the more than 15 million Americans who suffer from coronary heart disease.
A recently published study led by Yale School of Public Health researchers found that some of these patients—especially women and some minority groups—leave the hospital with their risk factors unaddressed or poorly managed. The research, which appears in Journal of Women’s Health, evaluated five cardiac risk factors and management strategies by age, sex and race among 2,369 patients hospitalized for acute myocardial infarction.
“We found that patterns of major cardiac risk factors and secondary prevention efforts varied by age, sex, and race, with black women having a disproportionate burden of multiple risk factors,” said Erica Leifheit-Limson, Ph.D., a research scientist at the School of Public Health and the study’s lead author. “Our findings highlight missed opportunities for both the prevention and management of cardiac risk factors, particularly among women and minority patients.”
About 93 percent of the patients in the study had at least one of the five risk factors evaluated, including hypertension, hypercholesterolemia, current smoking, diabetes and obesity.
African-American patients were much more likely to have multiple risk factors than their Caucasian peers, and African-American women had the greatest risk factor burden of any of the subgroups, the study found. Sixty percent of older African-American women had three of the five risk factors that contribute to heart disease.
Differences in risk factor modification efforts based on race were also found. Both older and younger African-American women who smoked were, for example, less likely to receive counseling on smoking cessation.
Judith Lichtman, Ph.D., associate professor at YSPH and the study’s senior author, said that “we often focus on individual risk factors, but we found that almost half of patients who present to the hospital actually have three or more potentially modifiable risk factors for heart disease. We need to do a better job of managing modifiable risk factors in our society to reduce the burden of heart disease, particularly for black women.”
The Yale School of Public Health collaborated on the study with colleagues from several institutions, including Harlan M. Krumholz of the Yale School of Medicine, Yale-New Haven Hospital and YSPH; Kimberly J. Reid of St. Luke’s Mid America Heart Institute; John A. Spertus of the University of Missouri-Kansas City and St. Lukes; Viola Vaccarino of Emory University Rollins School of Public Health and the School of Medicine; and Sarah B. Jones of YSPH.