BACKGROUND: Black women are less likely to be evaluated and treated for anginal symptoms, despite a higher premature cardiac mortality rate compared to white women. Our objective was to compare angina symptoms in black versus white women regarding (1) angina symptoms characterization; (2) relationship with obstructive coronary artery disease (CAD); and (3) relationship with subsequent mortality. METHODS: A cohort of 466 women (69 black and 397 white) undergoing coronary angiography for suspected ischemia and without prior history of CAD completed symptom checklists. Four symptom clusters (CHEST, UPPER, STOMACH, and TYPICAL TRIGGERS) were derived by factor analysis. All angiograms were analyzed by core lab. Mortality data over 10 years were obtained from National Death Index. RESULTS: (1) Black women had lower mean CHEST cluster scores (0.60±0.30 vs. 0.73±30, p=0.002), but higher STOMACH scores (0.41±0.25 vs. 0.30±0.25, p=0.011) than white women. (2) Prevalence and severity of CAD did not differ in black and white women and was not predicted by symptom cluster scores. (3) All-cause mortality rates were 24.9% in blacks versus 14.5% in whites, p=0.007; and cardiovascular mortality 22.5% vs.8.8%, p=0.001. Symptom clusters were not predictive of adverse events in white women. However, black women with a low TYPICAL score had significantly higher mortality compared to those with a high TYPICAL score (43% vs. 10%, p=0.006). CONCLUSIONS: Among women undergoing coronary angiography, black women report fewer chest-related and more stomach-related symptoms, regardless of presence or severity of CAD, and these racial symptom presentation differences are linked with the more adverse prognosis observed in the black women. Atypical symptom presentation may be a barrier to appropriate and timely diagnosis and treatment and contribute to poorer outcomes for black women.
BACKGROUND: Black women are less likely to be evaluated and treated for anginal symptoms, despite a higher premature cardiac mortality rate compared to white women. Our objective was to compare angina symptoms in black versus white women regarding (1) angina symptoms characterization; (2) relationship with obstructive coronary artery disease (CAD); and (3) relationship with subsequent mortality. METHODS: A cohort of 466 women (69 black and 397 white) undergoing coronary angiography for suspected ischemia and without prior history of CAD completed symptom checklists. Four symptom clusters (CHEST, UPPER, STOMACH, and TYPICAL TRIGGERS) were derived by factor analysis. All angiograms were analyzed by core lab. Mortality data over 10 years were obtained from National Death Index. RESULTS: (1) Black women had lower mean CHEST cluster scores (0.60±0.30 vs. 0.73±30, p=0.002), but higher STOMACH scores (0.41±0.25 vs. 0.30±0.25, p=0.011) than white women. (2) Prevalence and severity of CAD did not differ in black and white women and was not predicted by symptom cluster scores. (3) All-cause mortality rates were 24.9% in blacks versus 14.5% in whites, p=0.007; and cardiovascular mortality 22.5% vs.8.8%, p=0.001. Symptom clusters were not predictive of adverse events in white women. However, black women with a low TYPICAL score had significantly higher mortality compared to those with a high TYPICAL score (43% vs. 10%, p=0.006). CONCLUSIONS: Among women undergoing coronary angiography, black women report fewer chest-related and more stomach-related symptoms, regardless of presence or severity of CAD, and these racial symptom presentation differences are linked with the more adverse prognosis observed in the black women. Atypical symptom presentation may be a barrier to appropriate and timely diagnosis and treatment and contribute to poorer outcomes for black women.
Authors: M A Hlatky; R E Boineau; M B Higginbotham; K L Lee; D B Mark; R M Califf; F R Cobb; D B Pryor Journal: Am J Cardiol Date: 1989-09-15 Impact factor: 2.778
Authors: Marian B Olson; Sheryl F Kelsey; Karen Matthews; Leslee J Shaw; Barry L Sharaf; Gerald M Pohost; Carol E Cornell; Susan P McGorray; Diane Vido; C Noel Bairey Merz Journal: Eur Heart J Date: 2003-08 Impact factor: 29.983
Authors: Diane Klingler; Robbya Green-Weir; David Nerenz; Suzanne Havstad; Howard S Rosman; Leonard Cetner; Samir Shah; Frances Wimbush; Steven Borzak Journal: Am Heart J Date: 2002-07 Impact factor: 4.749
Authors: Candace S Brown; Davis C Foster; Candi C Bachour; Leslie A Rawlinson; Jim Y Wan; Gloria Ann Bachmann Journal: J Womens Health (Larchmt) Date: 2015-08-20 Impact factor: 2.681
Authors: Thomas Rutledge; Tanya S Kenkre; Diane V Thompson; Vera A Bittner; Kerry Whittaker; Jo-Ann Eastwood; Wafia Eteiba; Carol E Cornell; David S Krantz; Carl J Pepine; B Delia Johnson; Eileen M Handberg; C Noel Bairey Merz Journal: J Behav Med Date: 2016-03-26
Authors: Eileen M Handberg; Jo-Ann Eastwood; Wafia Eteiba; B Delia Johnson; David S Krantz; Diane V Thompson; Viola Vaccarino; Vera Bittner; George Sopko; Carl J Pepine; Noel Bairey Merz; Thomas R Rutledge Journal: Womens Health (Lond) Date: 2013-09
Authors: B Gwen Windham; Kimystian L Harrison; Seth T Lirette; Pamela L Lutsey; Lisa A Pompeii; Kelley Pettee Gabriel; Silvia Koton; Lyn M Steffen; Michael E Griswold; Thomas H Mosley Journal: J Am Geriatr Soc Date: 2017-02-06 Impact factor: 5.562