Risk factors and the natural history of coronary heart disease in blacks.

Contrary to early impressions of blacks' relative immunity to CHD, it is now clear that African Americans experience greater mortality from CHD than whites. The natural history of CHD differs between blacks and whites in three important respects: First, greater prevalence of established risk factors among blacks suggests that they may be at greater risk for heart disease than their white counterparts. Second, health care seeking differences are evident between blacks and whites, leading to lower rates of identification of early disease and slower seeking of services for acute events. However, risk factor differences and health care seeking behaviors do not appear to account for all of the differences in the natural history of heart disease between the ethnic groups, such as survival rate differences during treatment. Economic factors appear to account for only a portion of these differences in risk factors and health care seeking. Beyond differences in risk factors and health care seeking, other, as yet undetermined, factors seem to be involved. These unknown influences could include physiologic, behavioral, and/or psychologic differences.