Epidemiology of atherothrombotic disease and the effectiveness and risks of antiplatelet therapy: race and ethnicity considerations.

Cardiovascular disease is the leading cause of death in the United States, accounting for approximately 60% of total mortality in 2002. There is evidence that race and ethnicity is a risk factor for atherothrombotic events. Blacks have a greater risk of complications from coronary heart disease and unstable angina, with a higher coronary heart disease death rate compared with whites. The risk of ischemic stroke is 2-4 times higher among blacks compared with whites, whereas the risk of peripheral arterial disease is highest among non-Hispanic blacks. Additionally, Asian-Pacific Islander ethnicity is an independent risk factor for bleeding, even though this ethnic group receives less antithrombotic therapy compared with whites. The increased risk of events in these patient populations may have its basis in racial and ethnic differences in the pathobiology of atherosclerosis. Some racial and ethnic populations are also inadequately prescribed antiplatelet therapy despite their higher risk. Although this difference in therapy is hard to explain, it is becoming clear that factors other than socioeconomic status or clinical presentation are influencing racial differences in physician provisions of therapy. Antiplatelet therapy, including aspirin and clopidogrel, is an important component of risk reduction strategies, and there are few data to suggest racial or ethnic variations in drug efficacies. Thus, understanding and overcoming race and ethnicity-related treatment disparities should lead to significant clinical improvements in these under-served populations.