Michelle A. Albert, MD, MPH: Racial Discrepancies in Cardiovascular Outcomes

There might be no field in medicine with a bigger racial or ethnic disparity in treatment outcomes than cardiology.

While there are several complex reasons for the discrepancy in outcomes, better clinical trials could ultimately yield better results.

In an interview with HCPLive®, Michelle A. Albert, MD, MPH, Professor in Medicine at the University of California at San Francisco (UCSF) and Director of the CeNter for the StUdy of AdveRsiTy and CardiovascUlaR DiseasE (NURTURE Center), explained why this discrepancy exists and what can be done to close some of the gaps in cardiovascular health.

HCPLive: Within the area of cardiology is there a specific disease or disorder where there’s the largest racial discrepancy that we really need to close in terms of treatment?

Albert: I would say that disparities exist in all of the major areas of medicine, but the biggest gaps in mortality and morbidity lie in the relationship with cardiovascular disease. Cardiovascular disease is the number 1 killer worldwide, driven by hypertension and the downstream effects of hypertension.

High blood pressure and cardiovascular disease as an entire entity drive a significant proportion of the disparities.

HCPLive: Do you think this is more of a treatment problem or a screening and diagnostics problem or a lack of understanding of the underlying impact of the disease and what causes it that drives the disparity?

Albert: I would say that it's a multi layered problem, largely driven by social determinants of health interplayed with access to quality health care interplayed with information and poverty. I would say that those are the major factors.

HCPLive: Has this gap closed any in the last 5-10 years?

Albert: Unfortunately, the gap has not closed. It was closing about a decade ago, but there is evidence that this gap is beginning to widen.

We know that blacks have the lowest life expectancy in the United States. Black men have a life expectancy that is almost 10 years lower than the group with the highest life expectancy, which are Asian Americans. So, the life expectancy for Asian Americans is somewhere around 83 years old, black men is somewhere around 75 years old, black women is about 78 years old.

HCPLive: If you could to one thing either by federal policy or industry change to close this gap and help people what would it be?

Albert: I would say promoting affordable health care that’s accessible to all would be the overarching thing. And the next would be paying a lot more attention to supporting the efforts around preventative health care.

HCPLive: Do you think the COVID-19 pandemic has increased the disparities in cardiology and will have a big impact in the future?

Albert: So, we'll see the statistics as they come out. However, we do know that COVID-19 has amplified already existing disparities by race, ethnicity, and socioeconomic status. We know that 1 in 1000 blacks have died from COVID-19, compared to for example, 1 in about 2800 to 3000 Asian Americans and whites.

We know that the COVID-19 pandemic has severely affected black Americans, Hispanic or Latinx Americans and native or indigenous populations in the United States.