Racial Disparities in Adverse Cardiovascular Outcomes After a Myocardial Infarction in Young or Middle-Aged Patients Open Access

Garcia, Mariana (Spring 2021)

Permanent URL: https://etd.library.emory.edu/concern/etds/m039k599s?locale=en



Black patients tend to develop coronary artery disease at a younger age than other groups. Previous data on racial disparities in outcomes of myocardial infarction (MI) have been inconsistent and limited to older populations. Our objective was to investigate racial differences in the outcome of MI among young and middle-aged patients and the mediating role played by socioeconomic (SES), psychosocial and clinical differences.



We studied 313 participants (65% non-Hispanic Black) <61 years old hospitalized for confirmed type 1 MI at Emory-affiliated hospitals and followed them for 5 years. We used Kaplan Meier survival analysis and Cox proportional-hazard models to estimate the association of race with a composite endpoint of recurrent MI, stroke, heart failure or cardiovascular death after adjusting for demographic, SES, psychological and clinical risk factors.



The mean age was 50 years and 50% were women. Compared with non-Black patients, Black patients had lower SES and more clinical and psychosocial risk factors, but less angiographic coronary artery disease. The 5-year incidence of cardiovascular events was higher in Black (35%) compared to non-Black patients (19%): hazards ratio (HR) 2.1, 95% confidence interval (CI), 1.3-3.6. Adjustment for SES weakened the association (HR 1.3, 95% CI, 0.8-2.4) more than adjustment for clinical and psychological risk factors. Low income, which was defined as earning less than 35 thousand dollars a year, explained 46% of the race-related disparity in outcome.



Among young and middle-aged adult survivors of an MI, Black patients have a two-fold higher risk of adverse outcomes, which is largely driven by upstream socioeconomic factors, rather than downstream psychological and clinical risk factors. This suggests the need for greater emphasis on policy-level interventions, rather than biomedical or behavioral ones. 

Table of Contents

Introduction: page 1

Background: pages 2-3

Methods: pages 4-8

Results: pages 9-11

Discussion: pages 12-15

Conclusion: page 16

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