Identifying Gender and Racial Disparities in Heart Attack Care

UNC researchers are spreading the word about these disparities and starting a conversation about how to change them.

When it comes to heart attack prevention and care, women are being treated differently than men, and black patients differently than white patients, according to UNC research.

A team led by Sameer Arora, MD, a cardiovascular disease fellow and a preventive medicine resident at the UNC School of Medicine, discovered these differences by examining information collected by the Atherosclerosis Risk in Communities study. Atherosclerosis is a term for the buildup of plaque in your arteries, a sign of heart disease.

The study started in 1987 in four U.S. communities and followed thousands of patients for decades to monitor heart disease, treatments and outcomes. It has provided a wealth of knowledge for researchers to better understand heart attack treatment in the U.S.

As Dr. Arora explains, medicine is making advances in heart attack treatment, but care is lacking in some concerning areas.

What overall theme have you noticed in heart attack occurrence and treatment?

It’s quite simple. Overall the treatments have improved, but these improvements have not been distributed equally across different races and genders.

What did your research find?

One of our studies, published in the American Heart Association journal Circulation, found that while fewer people overall are being hospitalized from heart attacks, that trend is not reflected in younger patients ages 35 to 54, especially women in that age range. That means while everyone else is having fewer heart attacks, women in this age group are having more, and they are slowly making up a larger percentage of the total heart attack rate. On top of that, young women are not only having more heart attacks than they used to, they aren’t receiving the same treatment as men.

We found similar disparities between black and white heart attack patients in another study published in the Journal of the American Heart Association. We saw that black patients were less likely than white patients to receive aggressive treatment or to be given certain types of medications commonly prescribed under current treatment guidelines. So the disparity we found between women and men exists between black and white patients too, even though there are clear suggestions on how to treat patients with their conditions.

It has been decades since researchers have proven the benefits of certain medications and treatments for heart attacks and how to prevent future cardiac events. It’s worrisome that we have differences in treatment and outcomes in this day and age.

Why do these disparities exist?

There are multiple factors leading to these disparities. But they likely begin at the level of preventive care—routine visits to the doctor when you are younger to make sure you are doing everything you can to prevent poor health as you age. For both women and black people, access to a primary care doctor and the ability to get to or pay for routine office visits can be challenging. Without these routine checkups, there’s really no way to know if someone is at a higher risk of heart disease or heart attack, and there’s no opportunity to turn things around if they are at risk.

This means that when these people do come to the hospital for heart disease or a heart attack, their overall health is poor. In our studies, we found that black and female patients tend to have more comorbidities, or other medical conditions, in addition to their heart issues. Comorbidities can present complications for treatment. A person may not be as good a candidate for surgery, or they may not react as well to the same medication as an otherwise healthy person. Because of that, we found that physicians are less likely to give heart attack patients with comorbidities the same treatment as a patient with fewer or no comorbidities. With that said, possible inherent bias by physicians can’t be ruled out.

How can we reduce these disparities?

Multifaceted approaches are needed to begin changing the way vulnerable populations receive treatment. Starting with access to primary care will help both of these patient populations [women and black people] by getting them regular medical care and reducing their comorbidities if a heart issue does arise.

Women are facing an additional, unique hurdle to equal care—there’s just less information on what heart attack looks like in them and how they should be treated. That starts with research. Research studies and clinical trials are made up of a majority of men, and more women should be included to develop a better knowledge of how to prevent heart attacks and treat them specifically in women.

What can concerned people do to advocate for themselves?

If you have a primary care physician, ask if their office or the hospital they are associated with has a patient navigator. This person can help prepare you for appointments so you can get the information you want from your physician and make the best health care decisions.

If you do not have a primary care physician, screenings for heart disease risk factors are sometimes offered at health fairs, churches, community agencies or your local health department. In North Carolina, the Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) program is offered by the North Carolina Department of Health and Human Services. It provides cardiovascular screening and services for women enrolled in the WISEWOMAN breast and cervical cancer screening program.

Everyone should ask their provider what their ASCVD (atherosclerotic cardiovascular disease) risk score is. This score provides an estimate of your likelihood of developing cardiovascular disease in the future. If your risk score is high, you should ask if there are changes in dietary patterns or certain medications that can help reduce your risk of having a heart attack.

Need to talk to a primary care doctor about your heart health? Find one near you.