Looking at data, differently

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 - Mary Tierney

Data released last month in JAMA revealed a 50 percent drop in the cardiovascular disease (CVD) mortality rate among Americans between 1980 and 2015. That’s a clear victory—but CVD is still our nation’s leading cause of death.

Conversely, mortality rates due to atrial fibrillation, endocarditis and peripheral arterial disease have increased since 1980. Also troubling is the fact that the U.S. has one of the highest death rates from CVD compared to other high-income countries.

We know there are regional variations among cardiovascular diseases across the U.S. as well as across racial, sex, geography and socioeconomic segments. CVD mortality depends on where you live and where you are treated. Rates of CVD mortality were lowest in areas surrounding San Francisco, Denver, Minneapolis and Miami and in northern Nebraska and northeastern Virginia. As the authors noted: “These findings suggest major efforts are still needed to reduce geographic variation in risk of death due to ischemic heart disease and cerebrovascular diseases.”

Reducing variation was the quest of one study presented last month at SCAI that looked at data differently, with an eye toward better outcomes for a broader scope of patients. They sought to understand the primary determinants and beneficial effects on health to better inform patient and practice management.

The study showed that being a white male could yield better outcomes when it comes to undergoing a PCI with a drug-eluting stent. Women and minorities have worse outcomes, which the research team directly attributed to their race, ethnicity, sex and socioeconomic status, rather than the PCI. Women and minorities, when compared to white men, they found, are at greater risk of experiencing recurrent cardiac events within the first year after PCI.

What is unique is this is the first prospective study to enroll only women and minorities (black, Hispanic, American Indian or Alaskan Native), traditionally underrepresented groups in cardiovascular study. “It shows that you can rapidly enroll women and minorities into a prospective registry and collect statistically valid data,” said lead researcher Wayne Batchelor, MD.

The study showed that clinical and angiographic risk factors, such as renal disease, diabetes, hypertension and coronary calcification, were more common in nonwhites and females than in white men, a group that was more likely to experience thrombus. Additionally, death, MI and target vessel revascularization rates were all higher among nonwhite, female patients.

While the study found significant differences in adjusted outcomes between the groups, higher risks of cardiac events in minority women emerged at one year. “These incremental risks appeared to be related to progression of the patient's ischemic heart disease more than failure of the stent due to stent thrombosis or restenosis," Batchelor said.

Let’s hope this study is the first of many. It takes a fresh look to change minds and practice for all patients.