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

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