A retrospective study on the effect of race and gender on the development, presentation and management of ischaemic heart disease

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Date
2004-11
Authors
Fourie, Jolande
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University of the Free State
Abstract
English: Cardiovascular Disease (CVD) is the leading cause of death of both men and women in the United States, with ischaemie heart disease (IHD) being the leading cause of death in women aged 60 and older, outnumbering the next 16 causes combined (Welty, 200 I). Age adjusted Coronary Heart Disease (CHD) death rates per 100 000 of the population for African American men and women were 262.0 and 176.7, 15% and 28% higher than those observed for Whites (Watkins, 2004). Due to the large number of deaths caused by CVD in different race and gender groups, the effect of race and gender on the development and progression of ischaemie heart disease (IHD) is the factor investigated in this study. Currently, many factors have been associated with increased risk to development and rapid progression of IHD, and many more are being reported. Identification of high-risk populations or individuals, and then controlling these predisposing factors (eg diabetes mellitus, blood pressure, cholesterol and smoking) can delay and reduce progression of IHD and its complications. The risk factors that are still in controversy are 'race' and 'gender'. This research revealed that CHD presents among females (especially in the white population), approximately 10 years later than for males. These findings are similar to those already reported in the literature. In terms of race, this study showed that black males had a higher insidence of myocardial infarctions than the white males. This is also probably responsible for the lower left ventricular function in the black males. The left ventricular dysfunction being more prominent in the black males is surely also responsible for the higher use of Angiotensin Converting Enzyme (ACE)-inhibitors, diuretics and nitrates (drugs commonly used in heart failure) in the black males when compared to the white males. Unfortunately, race and gender has not been recognized as a major factor in the assessment and management of patients with cardiovascular disease. This is partly due to the conflicting reports on some of these observations, as well as the difficulty in conducting studies on race and gender differences, owing to many factors that often affect and, perhaps, obliterate the race and gender factor. The purpose of this research is to investigate the role of race and gender on the development (risk factor profiles), presentation and management (treatment and response to treatment) in patients with ischaemie heart disease. Race and gender in IHO were assessed according to the following objectives: • A literature evaluation of data on 'race and gender and ischaemie heart disease risk' over the past 10 years (1994 - 2004) to explore the significance of this information to health care. Risk factors for IHO, presentation and treatment ofIHO were evaluated. • A review of the patients undergoing heart catheterization for clinically significant myocardial ischaemia during 2001 and 2002 in the department of Cardiology, Universitas Hospital, Bloemfontein was performed to investigate the effect of race and gender on the following: • risk factor profile • clinical presentation (including angiographic data) • treatment • response to treatment. The information was analysed and compared to the results of the literature evaluation. Insight into the race and gender differences in CHO in terms of risk factors, presentation and management is sought, to determine the differences in the disease manifestations or in the use of medical resources among various groups, by reviewing the available information in order to illustrate the need for earlier diagnosis and more timely, aggressive and appropriate treatment for specific race and gender groups. This will also be helpful in guiding management and allocation of medical resources. This research clearly indicates that there is indeed reason for race and gender to be recognized as major factors in the assessment and management of patients with ischaemie heart disease in order to ensure the rapid development of a strategy to optimally manage the growing number of patients with ischaemie heart disease. cardiovascular disease· coronary heart disease· ischaemie heart disease· race . gender· risk factors for ischaemie heart disease· presentation of ischemic heart disease· treatment of ischemic heart disease· angina· myocardial infarction
Afrikaans: Kardiovaskulêre siekte is die hoof oorsaak van sterftes by mans en dames in die Verenigde State van Amerika, met isgemiese hartsiekte wat die hoof oorsaak is van sterftes by dames ouer as 60 jaar - dit oortref die volgende 16 oorsake gekombineerd (Welty, 2001). Ouderdom aangepaste koronêre hartsiekte sterfte syfers per 100 000 vir Afrika-Amerikaanse mans en dames was 262.0 en 176.7, 15% en 28% hoër as dié waargeneem vir blankes (Watkins, 2004). As gevolg van die groot aantal sterftes veroorsaak deur kardiovaskulêre siekte in verskillende ras- en geslagsgroepe, is die effek van ras en geslag op die ontwikkeling en progressie van isgemiese hartsiekte die faktor wat in hierdie studie ondersoek is. Tans, word verskeie faktore geassosieer met toenemende risiko vir die ontwikkeling en spoedige progressie van isgemiese hartsiekte, en verskeie meer word gerapporteer. Identifisering van hoë risiko populasies of individue, en die kontrolering van die vatbare faktore (bv. diabetes mellitus, bloeddruk, cholesterol en rook), kan die progressie van isgemiese hartsiekte en die komplikasies daarvan verminder. Die risiko faktore waaroor daar steeds polemiek bestaan is 'ras' en 'geslag' . Hierdie navorsing het getoon dat koronêre hartsiekte presenteer ongeveer 10 jaar later in dames (veral in die wit bevolkingsgroep) as by mans. Hierdie bevindinge stem ooreen met dié wat in die literatuuroorsig gerapporteer is. Ten opsigte van ras, het hierdie studie getoon dat daar 'n hoër voorkoms van miokardiale infarksies by swart mans is as by blanke mans Hierdie voorkoms is waarskynlik verantwoordelik vir die laer linker ventrikulêre funksie in swart mans. Die linker ventrikulêre disfunksie wat meer prominent is by swart mans is sekerlik ook verantwoordelik vir die hoë gebruik van Angiotensien Omskakelings Ensiem (ACE)-inhibitore, diuretika en nitrate (middles wat algemeen gebruik word vir die behandeling van hartversaking) by swart mans teenoor die van blanke mans. Ongelukkig is ras en geslag nie erken as belangrike faktore in die skatting en hantering van pasiënte met kardiovaskulêre siekte nie. Dit is deels as gevolg van die teenstrydige verslae van sommige van die waarnemings, sowel as die probleem om studies op ras en geslagsverskille uit te voer. Dit is te wyte aan verskeie faktore wat dikwels die ras en geslagsfaktore affekteer en kan vernietig. Die doel van die navorsing is om die rol van ras en geslag op die ontwikkeling, (risiko-faktor profiel), voorstelling en hantering (behandeling en respons op behandeling) in pasiënte met isgemiese hartsiekte te ondersoek. Ras en geslag in isgemiese hartsiekte IS In ooreenstemming met die volgende doelwitte nagevors: • 'n Literatuur evaluasie van data oor 'ras en geslag en isgemiese hartsiekte risiko' oor die afgelope 10 jaar (1994 - 2004) om die betekenis van die inligting vir gesondheidsorg te bepaal. Risiko faktore vir isgemiese hartsiekte, voorstelling en behandeling van isgemiese hartsiekte is geevalueer. • 'n Oorsig van pasiënte wat hartkateterisasie ondergaan het vir klinies betekenisvolle miokardiale isgemie gedurende 200 I en 2002 in die departement van Kardiologie, Universitas Hospitaal, Bloemfontein IS uitgevoer om die effek van ras en geslag op die volgende te bepaal: • risiko-faktor profiel • kliniese voorkoms (insluitend angiografiese data) • behandeling • respons op behandeling. Die inligting is geanaliseer en vergelyk met die inligting wat deur die literatuur evaluasie verkry is. Insig in die ras- en geslagsverskille in koronêre hartsiekte in terme van risiko faktore, voorstelling en hantering word nagestreef, ten einde die verskille in die siekteverskynsels of in die gebruik van mediese hulpbronne in verskillende groepe te bepaal. Deur die beskikbare inligting na te gaan is die behoefte vir vroeë diagnoses en meer tydige, aggressiewe en geskikte behandeling vir bepaalde rasse en geslagsgroepe vasgestel. Hierdie inligting kan van groot waarde wees om die hantering van pasiënte en allokering van mediese hulpbronne te rig. Hierdie navorsing het duidelik aangetoon dat ras en geslag belangrike faktore is in die assessering en hantering van pasiënte met isgemiese hartsiekte. Die inligting kan die spoedige ontwikkeling van 'n strategie vir optimale hantering van die toenemende aantal pasiënte met isgemiese hartsiekte verseker. Kardiovaskulêre siekte· koronêre arterie siekte· isgemiese hartsiekte· ras· geslag· risiko faktore vir isgemiese hartsiekte· kliniese voorkoms van isgemiese hartsiekte· behandeling van isgemiese hartsiekte· angina· miokardiale infarksie
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Keywords
Myocardial infarction, Coronary heart disease -- Treatment, Coronary heart disease -- Sex factors, Coronary heart disease -- South Africa, Dissertation (M.Med.Sc. (Pharmacology))--University of the Free State, 2004
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