Minorities have more MI risk factors, but targeted less by prevention efforts

Black patients often have multiple risk factors for acute myocardial infarction (AMI), but secondary prevention efforts target white patients more often. In a study published in the August issue of the Journal of Women’s Health, researchers found that black women bear the highest AMI risk factor burden, but are less likely to be prescribed preventive medications.

“Currently, there are an estimated 15.4 million Americans diagnosed with CHD [coronary heart disease] for whom risk factor modification can reduce the risk of recurrent events and death,” wrote the authors, led by Erica C. Leifheit-Limson, PhD, of Yale School of Public Health in New Haven, Conn.

However, they added, “research is limited for younger and minority populations of AMI patients, particularly women, and how their risk factor prevalence and secondary prevention treatments compare with older and white patients.”

The Prospective Registry Evaluating Myocardial Infarction: Events and Recovery (PREMIER) study included more than 2,300 AMI patients from 19 U.S. centers. They were all 18 years or older and had elevated cardiac enzymes within 24 hours of admission to a hospital as well as other evidence of an AMI. PREMIER was funded by CV Therapeutics and CV Outcomes.

By looking at medical records and conducting patient interviews, the researchers determined whether the participants had any of five potentially modifiable risk factors: hypertension, hypercholesterolemia, diabetes, obesity and current smoking.

They also determined what secondary prevention efforts were started at the time of discharge, specifically, prescriptions for antihypertensives for patients with high blood pressure, cholesterol-busting drugs for patients with hypercholesterolemia, instructions on how to quit smoking, instructions on managing diabetes and instructions on improving diet and losing weight.

The vast majority of patients (93 percent) had at least one risk factor, 72 percent had two or more and 40 percent had three or more. Participants who had multiple risk factors were mostly black—60 percent of older black women and 54 percent of younger black women had three or more risk factors.

Despite the prevalence of risk factors among minorities, they were less likely to be prescribed blood pressure medications or lipid-lowering medications. Black patients also received less guidance on smoking cessation than white patients. There were no significant differences between the age-sex groups in terms of diabetes management and weight management.

Their data, the authors argued, highlight how critical it is to be aware of CHD risk in certain segments of the population.

“Identifying patients in need of multiple risk factor management as well as understanding the utilization of discharge medications and other secondary prevention efforts post-AMI, may help target intervention strategies to decrease the risk for recurrent events and improve patient outcomes in more vulnerable populations,” the authors wrote.