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Racial Disparities in Coronary Artery Disease Prevalence
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TO THE EDITOR:
Johnson and colleagues [1] speculate that the lower rates of coronary disease in African-Americans compared with whites may be explained by the greater use by African-Americans of emergency departments as primary care facilities. Another explanation is the higher prevalence of hypertension among African-Americans, in that patients with hypertensive heart disease may present with ischemic symptoms but not have significant coronary artery disease.
In our recent study of consecutive African-American and white patients referred for coronary angiography [2], we also found a lower prevalence of coronary artery disease among African-Americans than among whites (71% compared with 84%, P < 0.05). African-American patients, however, had significantly more hypertension (78% compared with 52%, P < 0.05) and diabetes mellitus (36% compared with 23%, P < 0.05) than did white patients. In contrast to the present study, the degree of coronary artery disease as assessed by a coronary artery disease score was the same for the two races. Presenting symptoms can be unreliable in determining underlying disease [3]. Data on coexisting disease in the study by Johnson and associates may explain why African-American patients presenting with acute chest pain seem to have a lower prevalence of coronary artery disease.
Matthew J. Sorrentino
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
Include no more than 300 words of text, three authors, and five references
Type with double-spacing
Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright 2004 by the American College of Physicians
