8/15/2023 0 Comments Cedars sinai smidt heart institute![]() An age-adjusted Cox proportional hazards model for time to MACE, with race as an explanatory factor, included 180 events. The primary outcome for the composite of major adverse cardiovascular events (MACEs) included all-cause mortality, nonfatal myocardial infarction, stroke, and hospitalization for either angina or heart failure, which occurred in 45 (52%) Black women compared with 152 (33%) women of other races and ethnicities with INOCA ( Figure, ,A). Black women had lower levels of education (27.4% versus 14.7% P=0.0025), greater incidence of income <$20 000/year (56.8% versus 27.4% P<0.0001), and lower levels of health insurance coverage (Medicare: 26.5% versus 22.9% private: 36.8% versus 64.7% none: 11.8% versus 5.0% P<0.0001) compared with women of other races and ethnicities. More Black women reported being disabled (30.5% versus 18.1% P=0.0056), with significantly lower Duke Activity Status Index scores (18.3☑4.7 versus 22.6☑5.7 P=0.0065). Among participants with INOCA, Black women were significantly heavier (body mass index 32.2☖.8 versus 29.5☖.7 P=0.0003) and had greater proportions of diabetes (37% versus 12.9% P<0.0001) and hypertension (76.8% versus 49.2% P<0.0001) compared with women of other races and ethnicities. The non-Black cohort included predominantly White women, with smaller numbers of women of other races or ethnicities (Asian, Hispanic, Native American, or other). Of the 944 women included (mean age 58☑2 years 17% non-Hispanic Black), 61% (n=580) were diagnosed with INOCA. ![]() The data that support the findings of this study are available from the corresponding author upon reasonable request. No obstructive CAD was defined as <50% stenosis, categorized as INOCA. Angiograms were evaluated for coronary artery disease (CAD) by the core laboratory. Anthropometric measurements and information about medical history, demographics, self-reported race and ethnicity, and symptom burden were collected at baseline. A National Death Index search was performed to evaluate all-cause mortality through December 2007, extending the follow-up period to 11.2 years. Written informed consent was obtained from all participants. 3 Institutional review board approval was obtained from the participating sites (University of Alabama at Birmingham, University of Florida at Gainesville, University of Pittsburgh Medical Center, PA, and Allegheny General Hospital in Pittsburgh, PA). ![]() The original WISE cohort recruited eligible women 18 years of age or older with symptoms or signs of myocardial ischemia undergoing clinically indicated coronary angiography from September 1996 to March 2000 with telephone follow-up obtained through March 2006. ![]() We characterized the risk profile for Black women with INOCA and explored the factors associated with long-term adverse outcomes in this population. 3, 4 Little is known about the role of race and ethnicity in this prognosis. ![]() These women have unfavorable long-term prognoses, with elevated rates of adverse events and mortality at 5 and 10 years compared with case-matched asymptomatic women. Two-thirds of the original WISE cohort had symptoms or signs of myocardial ischemia with no obstructive coronary artery disease (INOCA). Over the past 2 decades, the WISE cohort studies (Women’s Ischemia Syndrome Evaluation) have provided data on pathophysiology for women with ischemic heart disease. 1, 2 Compared with their White counterparts, cardiovascular health for Black women is differentiated by a heavier burden of traditional risk factors, such as diabetes and hypertension, earlier development of cardiovascular disease, and nearly 20% higher rates of cardiovascular mortality. Cardiovascular disease remains the leading cause of death for women in the United States, with substantial racial and ethnic disparities. ![]()
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