African-Americans and heart disease:
Who has the highest risk of having CV disease?
African-American men have the highest risk of any group. Of American women, African-Americans have the highest risk (1). This disease destroys family relationships. The tragic loss of the generational wisdom of the elders to the community is staggering. Cardiovascular disease not only kills grandparents and great-grandparents, but young men and women in the prime of their lives. And cardiovascular disease (heart attacks, strokes, and sudden cardiac death) is preventable.
One of three Americans dies from heart attacks and strokes. That statistic has not changed since the early 1900s. The current standard of care, with it’s focus on treating coronary disease with stents and bypass surgery, isn’t working very well.
According to two studies, the COURAGE trial a decade ago, and now the ISCHEMIA trial, stents don’t prevent heart attacks or save lives in patients without chest pain (2,3,4,5). A new study published in July, 2020 compared cardiac events to race and ethnicity among 22,600 patients after having a stent in 10 randomized coronary stent trials. Within one year after the stent, black patients, compared to white patients, had a higher risk of MI (7% vs 5%) and death (3% vs 2%), Within 5 years after the stent, the risk for a major CV event was higher in blacks compared to whites (24% vs. 19%). Hispanics and Asians did not differ from whites in event rates, after adjustment for baseline CV risk (5).
How do we help people prevent heart attacks and strokes? We evaluate and treat lots of risk factors overlooked by the current standard of care. Of people who have heart attacks, half have a normal cholesterol (6). Of people who have heart attacks, 86% would have passed their stress test (if they had one) the day before the heart attack, because 86% of heart attacks occur in blockages that are not bad enough to need a stent (7).
What can you do?
Start by being informed. Watch the trailer of the movie “The Widowmaker” by clicking on the link below. It is available on Amazon Prime.
Get the book Beat the Heart Attack Gene, by our colleagues Drs. Brad Bale and Amy Doneen. Clicking on the button below takes you to the Amazon.com website where you can order this life-changing paperback for $14. This book could be a powerful gift for friends and family.
Do you know someone who had a recent heart attack? Ask whether your friend has been told about the risk of death within the first year after surviving a heart attack (19% for men, 26% for women) or within the first 5 years after the MI (36% for men, 47% for women) (12). Tell them about CardioSound. We help people prevent heart attacks and strokes. Our survival rate at 1 and 5 years after the MI is 100%. You might save your friend's life.
Imagine what it would be like to live without the fear of a cardiovascular event!
references:
National Vital Statistics Reports, 61:4 May 8, 2013 Data is available at the National Center for Health Statistics website: http://www.cdc.gov/nchs/deaths.html
Both the COURAGE trial in 2007, and the ISCHEMIA trial (made public in November, 2019), showed that procedures like stents don’t save lives or prevent heart attacks in patients with no chest pain. One exception in the ISCHEMIA trial was patients with left main coronary artery disease, who did benefit from bypass surgery. Even three-vessel disease (LAD, left circumflex and right coronary artery without left main disease) failed to benefit from bypass surgery without chest pain. Boden, William, et al. the COURAGE Trial Research Group, Optimal Medical Therapy with or without PCI for Stable Coronary Disease, N Engl J Med 2007; 356:1503-1516 DOI: 10.1056/NEJMoa070829.
In this analysis of 621 patients treated with medications in the COURAGE trial, anatomic plaque burden (ie, “How much plaque do you have?”) and ischemic burden (“How much is your plaque obstructing your blood flow?”) were compared. Anatomic plaque burden consistently predicted death and MI. Ischemic burden failed to predict these outcomes. (See ref. #1 above.) “Neither determination, even in combination, identified a patient profile benefiting preferentially from an invasive therapeutic
David J. Maron, M.D., et al. Initial Invasive or Conservative Strategy for Stable Coronary Disease N Engl J Med 2020; 382:1395-1407, April 9, 2020 DOI: 10.1056/NEJMoa1915922
Mordechai Golomb MD, et al. Prognostic Impact of Race in Patients Undergoing PCI: Analysis From 10 Randomized Coronary Stent Trials., JACC: Cardiovascular Interventions. Volume 13, Issue 13, 13 July 2020, Pages 1586-1595
Sachdeva et al. Lipid levels in patients hospitalized with coronary artery disease: an analysis of 136,905 hospitalizations in Get With The Guidelines. Am Heart Journal. 2009;157(1):111-117.e2.
70% obstruction (stenosis) is the benchmark for getting a stent. 86% of MIs occur in lesions that are less than 70% obstructed. 70% of MIs occur in lesions with less than 50% stenosis. E Falk, PK Shah, V Fuster. Circulation. 1995;92:657.