Insights into the pathophysiology of atherosclerosis and prognosis of black Americans with acute coronary syndromes

Background Disparities in prognosis for black and white patients with coron ary heart disease have been widely reported. For several reasons ii is uncl ear to what extent biologic factors contribute to these differences. Methods The current medical literature regarding the pathophysiologic chara cteristics of cardiovascular disease is reviewed with emphasis on how racia lly mediated biologic differences may affect the manifestation, treatment, and prognosis of patients with coronary heart disease, particularly patient s with acute coronary syndromes. Results Black patients with coronary heart disease have a higher prevalence of ischemic heart disease risk factors, including hypertension, left ventr icular hypertrophy, diabetes, and tobacco use. Other factors related to ath erosclerosis, vascular reactivity, and thrombolysis that quantitatively and functionally differ among racial groups are identified. Prospective, rando mized trials comparing outcomes among patients with acute coronary syndrome s have included only a fraction of the available black population, although they reveal a similar short-term mortality rate for black and white patien ts. Several factors, including enhanced fibrinolysis among black patients w ith acute myocardial infarction, may in part counterbalance better understo od and more prevalent comorbidities to equalize short-term (30-day) surviva l. All-cause, long-term (1-year) mortality appears worse for black patients compared with white patients with similar cardiovascular risk profiles. Conclusion As racially mediated biologic differences between black and whit e patients become better understood,targeted interventions to prevent coron ary heart disease and treat acute coronary syndromes in black patients can be developed.