A retrospective study on the effect of race and gender on the development, presentation and management of ischaemic heart disease

[摘要] English: Cardiovascular Disease (CVD) is the leading cause of death of both men andwomen in the United States, with ischaemie heart disease (IHD) being the leadingcause of death in women aged 60 and older, outnumbering the next 16 causescombined (Welty, 200 I).Age adjusted Coronary Heart Disease (CHD) death rates per 100 000 of thepopulation for African American men and women were 262.0 and 176.7, 15% and28% higher than those observed for Whites (Watkins, 2004). Due to the largenumber of deaths caused by CVD in different race and gender groups, the effect ofrace and gender on the development and progression of ischaemie heart disease(IHD) is the factor investigated in this study.Currently, many factors have been associated with increased risk to developmentand rapid progression of IHD, and many more are being reported. Identification ofhigh-risk populations or individuals, and then controlling these predisposingfactors (eg diabetes mellitus, blood pressure, cholesterol and smoking) can delayand reduce progression of IHD and its complications.The risk factors that are still in controversy are 'race' and 'gender'.This research revealed that CHD presents among females (especially in the whitepopulation), approximately 10 years later than for males. These findings aresimilar to those already reported in the literature.In terms of race, this study showed that black males had a higher insidence ofmyocardial infarctions than the white males. This is also probably responsible forthe lower left ventricular function in the black males. The left ventriculardysfunction being more prominent in the black males is surely also responsible forthe higher use of Angiotensin Converting Enzyme (ACE)-inhibitors, diuretics andnitrates (drugs commonly used in heart failure) in the black males when comparedto the white males.Unfortunately, race and gender has not been recognized as a major factor in theassessment and management of patients with cardiovascular disease. This is partlydue to the conflicting reports on some of these observations, as well as thedifficulty in conducting studies on race and gender differences, owing to manyfactors that often affect and, perhaps, obliterate the race and gender factor.The purpose of this research is to investigate the role of race and gender on thedevelopment (risk factor profiles), presentation and management (treatment andresponse to treatment) in patients with ischaemie heart disease.Race and gender in IHO were assessed according to the following objectives:�?A literature evaluation of data on 'race and gender and ischaemie heartdisease risk' over the past 10 years (1994 - 2004) to explore thesignificance of this information to health care. Risk factors for IHO,presentation and treatment ofIHO were evaluated.�?A review of the patients undergoing heart catheterization for clinicallysignificant myocardial ischaemia during 2001 and 2002 in the departmentof Cardiology, Universitas Hospital, Bloemfontein was performed toinvestigate the effect of race and gender on the following:�?risk factor profile�?clinical presentation (including angiographic data)�?treatment�?response to treatment.The information was analysed and compared to the results of the literatureevaluation.Insight into the race and gender differences in CHO in terms of risk factors,presentation and management is sought, to determine the differences in the diseasemanifestations or in the use of medical resources among various groups, byreviewing the available information in order to illustrate the need for earlierdiagnosis and more timely, aggressive and appropriate treatment for specific raceand gender groups. This will also be helpful in guiding management andallocation of medical resources.This research clearly indicates that there is indeed reason for race and gender to berecognized as major factors in the assessment and management of patients withischaemie heart disease in order to ensure the rapid development of a strategy tooptimally manage the growing number of patients with ischaemie heart disease.cardiovascular disease· coronary heart disease· ischaemie heart disease· race. gender· risk factors for ischaemie heart disease· presentation of ischemicheart disease· treatment of ischemic heart disease· angina· myocardialinfarction

[发布机构] University of the Free State