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15 October 1993 | Volume 119 Issue 8 | Page 861
Johnson and colleagues [1] speculate that the lower rates of coronary disease in African-Americans compared with whites may be explained by the greater use by African-Americans of emergency departments as primary care facilities. Another explanation is the higher prevalence of hypertension among African-Americans, in that patients with hypertensive heart disease may present with ischemic symptoms but not have significant coronary artery disease.
In our recent study of consecutive African-American and white patients referred for coronary angiography [2], we also found a lower prevalence of coronary artery disease among African-Americans than among whites (71% compared with 84%, P < 0.05). African-American patients, however, had significantly more hypertension (78% compared with 52%, P < 0.05) and diabetes mellitus (36% compared with 23%, P < 0.05) than did white patients. In contrast to the present study, the degree of coronary artery disease as assessed by a coronary artery disease score was the same for the two races. Presenting symptoms can be unreliable in determining underlying disease [3]. Data on coexisting disease in the study by Johnson and associates may explain why African-American patients presenting with acute chest pain seem to have a lower prevalence of coronary artery disease.
1. Johnson PA, Lee TH, Cook EF, Rouan GW, Goldman L. Effect of race on the presentation and management of patients with acute chest pain. Ann Intern Med. 1993; 118:593-601.
2. Sorrentino MJ, Vielhauer C, Eisenbart JD, Fless GM, Scanu AM, Feldman T. Plasma lipoprotein(a) protein concentration and coronary artery disease in black patients compared with white patients. Am J Med. 1992; 93:658-62.
3. Sorrentino MJ, Feldman T. Clinical and electrocardiographic limitations on the diagnosis of acute myocardial infarction: Implications for thrombolytic therapy. J Invasive Cardiol. 1990; 2:187-92. About Letters
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Racial Disparities in Coronary Artery Disease Prevalence
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