Acute Coronary Syndrome in African Americans and Hispanic Americans

Abstract

Among African Americans and Hispanics in the United States, coronary heart disease (CHD) is highly prevalent and is the single most frequent cause of myocardial infarction and death in that population [1]. However, multiple factors contribute to overall poorer care and worse outcomes among African Americans and Hispanics when compared with whites. These factors include difference in disease manifestation, socioeconomic status, access to care, patient perception of the health care system and of providers, attitudes of health care providers toward minority patients, therapeutic modalities and responses to treatment, and patient education. Although race-specifi c CHD data are sparse among black and Hispanic persons, rates of death among African Americans are among the highest in the industrialized world. This may be due to the complexities of race as a health factor or to controversies regarding whether health issues should even be considered in terms of race, as race is inextricably linked with socioeconomic status in the United States. Nevertheless, current data indicate that there are increasing disparities in cardiovascular health care among African Americans and Hispanics [1–3]. Compared with whites, African Americans are more likely to present with CHD at an earlier age, have higher out-ofhospital coronary death rates, and are more likely to have sudden cardiac death as the initial clinical presentation of CHD. Although the reasons for these differences are not well understood, it is possible that these health consequences are explained by signifi cant heterogeneity in acute coronary syndrome manifestation among African Americans. A high prevalence of certain coronary risk factors, delays in identifi cation and treatment of high-risk individuals, limited access to cardiovascular care, and lack of compliance and trust in the health care system appear to contribute to the burden of CHD among African Americans.